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Good Practice Guide

Resource Pack v6

16 October 2018

All Wales Primary Care Cluster Governance Framework

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Contents

Page

General Information

4 Components of Transformational Model for Primary and Community Care – Pack 2

9 Maturity Matrix for Clusters – Pack 3

14 Principles of Good Governance - The Health and Social Care Review – Pack 4

Cluster Development

17 Key elements to consider when forming a Cluster – Pack 6

15 Example of Cluster Vision and Mission – Pack 5

19 Sample Cluster Options Appraisal – Pack 7

28 Sample Cluster Terms of Reference – Pack 11

A PESTEL analysis

A SWOT analysis

34 Sample Terms of Reference for Cluster Leadership Group – Pack 12

22 Sample Cluster Voting System – Pack 8

86 Social Enterprise Toolkit for clusters – Pack 40

Population Needs

39 Integrated All-Wales Primary Care Needs Assessment – Pack 14

Cluster Project Planning

38 Sample Project Prioritisation Framework – Pack 13

77 Project Proposal Document – Pack 28

79 Primary Care Development Project Template – Pack 29

80 Goal Directed Plan Template – Pack 30

81 Project Action Plan Template – Pack 31

25 Sample Project Decision - Making Framework – Pack 10

51 Sample Decision-Tracker – Pack 19

82 Sample Highlight Report Templates – Pack 32

84 Post Project Review – Pack 33

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Impact Assessments

43 Integrated Impact Assessment – Pack 15

44 Equality Impact Assessment – Pack 16

45 Privacy Impact Assessment – Pack 17

Risk Assessment

23 Risk Management Guidance – Pack 9

Sample Risk Register

Sample Risk-scoring matrix

Project Evaluation

72 Logic Models in Evaluation – Pack 27

Business Case Development

46 Sample SBAR Template – Pack 18

87 Primary Care Project Initiation & Business Case Development Process – Pack 35

66 Business Case Template - Pack 26

85 Resource Shift Framework – Pack 34

88 FAQ Guide to Procurement – Pack 41

Workforce Development

94 Cluster Development - Knowledge, Skills and Training Survey – Pack 37

91 Protocol for Staff Employed by the Local Health Board working in GP Practices – Pack 36

52 Sample Cluster Lead Role – Pack 20

57 Sample Cluster Practice Manager Role – Pack 21

58 Sample Health Board Executive Lead for Clusters – Pack 22 awaiting information

59 Sample Cluster Support Manager – Pack 23

62 Sample Project Officer Manager – Pack 24

65 Sample Locality Manager – Pack 25 awaiting information

Information Governance

95 Data Sharing Agreement (DSA) – Pack 38

Communication and Engagement

98 Sample Cluster Communication and Engagement Strategy – Pack 39

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Resource Pack 2

Components of Transformational Model for Primary and Community Care

A transformational programme of change to primary care and community services is underway to safeguard the health and wellbeing of the people of Wales, building on the excellent services currently provided by professionals across the country. The new model takes a whole system approach to redesign, driven by national quality standards but with flexibility to respond to local community needs (see diagram Appendix 1). 1. Principles of Primary and Community Care Transformational Model The citizen is central to the new model, with inclusion of all ages and demographics. Access will ensure the right care is available at the right time from the right source, at or close to home. The model is founded on:

Service developments based on population need, with planning and transformation led through local primary care Clusters

Promotion of healthy living and the demedicalisation of wellbeing

A population focus as the basis for service planning and delivery across local communities

A more preventative, pro-active and co-ordinated primary care system which includes general practice and community service provision through community resource teams (CRTs) or frailty services

A whole system approach through the integration of health, local authority and voluntary sector services, facilitated by collaboration and consultation

Holistic care for citizens that incorporates physical, mental, and emotional wellbeing, linked to healthy life style choices

Integrated, streamlined care on 24/7 basis, focusing on the sickest patients during out of hours

Greater community resilience through empowered citizens and access to a range of community assets

Advice and support available to help people remain healthy, with easy access to local services for care when people need it

Strong multi-professional leadership across sectors and agencies to drive quality improvement

Technological solutions to improve access to information, advice & care and support self-care 2. Informed Public A shared understanding of the case for change, setting out what good looks like and explaining the benefits, is critical to success. Cultural change requires information, education, motivation and inspiration of the public to empower people to take ownership of their health. Communication strategies require a strong primary and community care focus to inform both public and professionals of the new models and service developments. Cultural differences between geographical areas may require different approaches to change behaviour. Involving children and young people in understanding the importance of self-responsibility is a key enabler for future change. Healthcare professionals use brief interventions and approaches including making every contact count (MECC) to make an impact on lifestyle behaviours and choices 3. Empowered Citizens Including people in the design of their local services, using feedback on user experiences and giving people active roles in the change process, all promote public empowerment. Local champions can share the value of primary and community care innovations through their own positive experiences. Motivational interviewing and coaching techniques have been found to be effective in supporting

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behaviour change. Patients and service users are encouraged to make informed choices together with their health and social care professionals. 4. Support for Self Care People are assisted to take responsibility for their health by building their knowledge, skills and confidence. Self care and taking responsibility is key to transformational change, with active involvement of people and carers in decisions about their care, and a range of local resources available to promote self-care and self-referral. Smart technology assists with monitoring, self-care and communications. 5. Community Services The model incorporates the ability for healthcare professionals in general practice to refer to a greater range of community services and pathways, with up-to-date information and advice on health and wellbeing. The model also includes non-clinical care and support in addition to clinical services. An increasing range of options for help and advice includes conversations with local health teams by phone, email or video call. Systems are designed to support decision-making and ensure there is access to the best professional or service when necessary. Community resources may be accessed through self-referral or by telephone triage acting as a social prescribing mechanism, with the use of Link Workers, Social Prescribers and technology to support signposting. It is essential that these local services are easily accessible, sustainable and meet the needs of the community. 6. Cluster Working Employment of staff to work across Clusters increases efficiency and ensures the local population has good access to clinical, social and managerial expertise. Cluster teams recruit professionals including pharmacists, physiotherapists, social workers, paramedics, physicians’ associates, occupational therapists, mental health counsellors, dieticians, third sector workers and other local authority staff to increase capacity for managing the everyday needs of the local population. PCOne Primary Care Roles General practice stability lies at the heart of the new model and is essential to ensure that local health services are sustainable and can respond to future demands. Local support from health boards helps to stabilise vulnerable GP practices and effective local workforce planning will ensure sustainability in the longer term. Cluster teams are breaking down artificial barriers within local health and social care systems to promote integrated care around the needs of the local population. Integrated working and cultural change are facilitated by joint contracts, shared learning sessions, co-location of staff and opportunities for professionals to rotate between different sectors. The emergence of various models that promote collaborative Cluster working, such as Federations, Social Enterprises and the Primary Care Hub, are aligned to this integrated multi-professional approach. 6. Clinical Triage / Telephone First Systems in General Practice Safe and effective call-handling and clinical triage systems at the front door of primary care are designed to direct people to the most appropriate professional / service, moving away from the current system in which the GP filters the majority of patient contacts. Telephone advice is appropriate for a significant proportion of people’s requests and, if given by a suitably experienced professional, can safely and effectively reduce the number of face-to-face consultations. This telephone first model, incorporating call handling (or care navigation) and clinical triage, has the potential to direct or signpost people beyond the multi- professionals around the GP. The telephone first / triage model is also about ensuring access to the right care from the right service in a timely way, directing people to:

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Clinical professionals integrated within the local multi-professional Cluster team, including optometric and dental professionals to manage eye, tooth and oral health problems; community pharmacists to manage common ailments and medication-related problems and physiotherapists to manage musculoskeletal problems

Non-clinical community services when appropriate, with referrals assisted by link workers or social prescribers who are integrated within the local multi professional team

7. 111 and Out-of-Hours Care The redesigned 111 Service ensures appropriate management of people with urgent needs in the out-of-hours period, with good communication systems to ensure that professional teams have access to contemporaneous clinical records. This is essential for seamless care across in- and out-of-hours, especially for patients with complex conditions and / or at the end of life. 111, supported by a national virtual directory of services, also acts as a social prescribing mechanism to signpost people 24/7 to local services and sources of help. 8. Direct access People can directly access a range of local health services that include: community pharmacists for advice and treatment for a range of common ailments; optometrists for advice and treatment of routine and urgent eye problems; dentists for toothache and oral health; physiotherapists for musculo-skeletal problems; audiologists for hearing problems. Some of these services may not be available yet everywhere but they are developing and transforming over time. 9. People with Complex Care Needs As a result of effective triage and enhanced multidisciplinary Cluster working, GPs and Advanced Practitioners have more time to proactively care for people with more complex needs at home or in the community - often the elderly with multiple co-morbidities. Significantly longer consultation times are required to assess, plan and coordinate anticipatory care. People who present with both health and social care needs can be supported by seamless care from community resource teams, frailty or other integrated local health and care teams. Complex issues arising from welfare, housing and employment problems can be better managed through a whole system, multi-professional approach. The Cluster team is also well placed to support care of the acutely ill within Virtual Wards and Community Hubs, working alongside specialist colleagues to care for those who would otherwise be admitted to hospital and risk losing their independence. Such community teams can also facilitate prompt discharge from hospital. This holistic multidisciplinary model therefore offers a more proactive and preventative approach to care, with people managed earlier in their care pathways when they respond better to education and support for self-care. The result is better outcomes and experiences for people and carers. The model has the potential for a wider range of planned care to be undertaken in the community, including outpatient appointments and treatments, and diagnostic tests. It could also reduce referrals to secondary care and unscheduled care admissions, allowing hospital staff to focus resources on the very sick and on planned specialist care.

10. Infrastructure to support Transformation The Primary Care Transformational Model must be underpinned by an infrastructure that is fit for purpose and designed to facilitate enhanced MDT working. Local health facilities, informatics and telephony systems need to be flexible and responsive to future changes, supporting multi-professional working and telephone first/triage components. Digital options to seek and receive care need to become commonplace. Direct access to diagnostic services in the community by Cluster clinicians is essential to the delivery of quality care closer to home.

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11. Anticipated Outcomes National and international research, taken alongside the evidence emerging from the Pacesetter Programme, indicates the potential benefits of the transformational model for primary and community care:

Improved citizens’ health and wellbeing Greater community resilience Better practitioner morale, motivation and wellbeing Increased recruitment and retention of primary care and community staff Sustainable models of care

Useful References NHS Wales Planning Framework 2018/21 Prosperity for All

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Maturity Matrix for Clusters - Components and Characteristics of Transformational Model for Primary Care v3 Resource Pack 3

Component

Characteristics

Level 1

Level 2

Level 3

Informed Public

Case for change agreed by whole cluster team Key messages for local communication agreed, aligned to national priorities Cluster stakeholder groups identified

Cluster Communication and Engagement Strategy agreed and publicised, including vision, purpose and functions of cluster

Systems and channels for public engagement/communication established, reflecting preferences of stakeholders

Communication and engagement with public & service users underway

Clear understanding by public of:

Case for change

New systems of care

How to access local information, advice, support and care

Cluster Communication and Engagement Strategy in active use, with wide range of communication methods and resources

Clear understanding of how to access health information & advice, including self care information and use of on line symptom checkers through 111

Empowered Citizens

Options for engaging and involving service users in information / service design have been researched and agreed by cluster team Widespread support for use of behaviour change techniques by professionals Resources are available to support culture and behaviour change amongst local stakeholders All members of cluster team understand and actively promote Making Choices Together and Every Contact Counts

Systems for promoting and receiving feedback from service users are established within the cluster

Active engagement and involvement of service user representatives in design of cluster services & assets

All members of cluster team trained in behaviour change techniques

All members of cluster team understand and actively use Making Every Contact Counts

All members of team trained in shared decision-making and use Making Choices Together techniques for a few prioritised conditions

All new & redesigned local services and assets developed through co-production with service user reps Service user feedback actively used in redesign of cluster services Evidence of widespread culture / behaviour change in stakeholders, with ownership of well-being and appropriate use of services

Local cluster champions in place to promote and support new initiatives

Service users actively encouraged and supported to make informed choices on all care and treatments

IT systems in place with designs to support decision-making

Activation measures used to monitor service user motivation& empowerment

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Support for Well-being, Disease

Prevention and Self Care

Options for signposting and care navigation systems have been researched and understood Smart technologies that support self-care and self-monitoring have been scoped and costed

Cluster plans and business cases address gaps in local services that promote well-being and self-care Signposting and navigation systems direct service users to information and support for self-care Technologies that support self-care are included in cluster business plans

Widespread information, advice and support are available to promote ownership of health and wellbeing, esp. amongst young people

Wide range of local health & wellbeing resources are available to support self-care, promoted through cluster signposting / navigation

Smart technologies in widespread use to support self-monitoring and self-care, especially for long term conditions

Pro active use of 111 /NHS Direct symptom checkers

Community Services

Cluster teams and Regional Partnership Boards use Population Needs & Wellbeing Assessments to fully understand community health and wellbeing requirements Cluster plans are integral to IMTPs of Health Boards and Local Authority planning mechanisms Existing cluster services and assets are scoped and analysed Gaps in cluster services and assets that support well-being, disease prevention, care and treatments within local community are actively addressed in next planning round

Cluster plans and business cases address gaps in local community services & assets through:

Prioritisation of cluster projects to address service needs

Service user reps involved in planning / design of all new services

Robust evaluation of initiatives to ensure value for money

Active consideration of factors relating to special needs, equality and health literacy is integral to prioritisation and design of services

Methods and technologies enabling service users to access support & advice from healthcare teams researched

Cluster services with direct access / self-referral routes are promoted e.g. community pharmacy, optometry,

Comprehensive up-to-date Directory of Cluster Services published, including sources of information, advice & support in choice of formats; accessible through national Directory of Service hosted on 111 platform with links to other national directories eg. DEWIS Cymru

Range of methods is available to access support, advice and treatment quickly and easily: e.g. phone, email, video-call

Systems for signposting are in place to direct people to community resources easily and quickly

Wide range of community services established for care and treatment, tailored to needs of the community and redressing health inequalities

Systems are in place to empower people with differing levels of health literacy and sensory impairments to access advice, care

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audiology and physiotherapy services and treatment

Cluster Working

Joint agreement by integrated cluster team on vision, purpose and functions of their cluster

Cluster strategy has been drawn up, shaped by cluster data and intelligence

Cluster Lead in post

Code of conduct and Terms of Reference is agreed by Cluster Stakeholder Team

Cluster workforce plans drawn up, based on assessment of population needs and cluster skills/capacity requirements.

Cluster operational model agreed through use of options appraisal, with legal advice sought as necessary.

Cluster governance framework in place, with robust processes for cluster decision-making, risk management and accountability for all partner organisations.

Integration and partnership working actively promoted within cluster

Cluster recruitment / sustainability plans agreed to ensure stability of Primary Care services

Primary Care training placements are established for cluster staff

Cluster model in operation to promote multidisciplinary approach & integrated care

Cluster partnership working is promoted through co-location of staff, joint contracts, shared learning, staff rotations, etc.

Range of professionals in post to increase capacity and expertise of cluster team, delivering holistic care closer to home

Contractual arrangements for cluster staff in place to ensure effective lines of accountability, robust indemnity and pension arrangements

All cluster professionals are supported by appropriate training, clinical supervision, mentorship arrangements GP practices and Primary Care services are stable and sustainable, employing a workforce trained in cluster environment

Call-handling, Signposting,

Clinical Triage / Telephone First

Systems

Clear understanding of cluster call-handling, signposting, clinical triage / Telephone First systems & processes by cluster team:

Purpose of each system

Benefits to service users & staff

Potential problems and challenges

Systems and processes required

Cost and infrastructure implications

Training and supervision requirements

Service users involved in designing feedback systems to evaluate call-handling, signposting and triage systems

Use of service user feedback to design signposting, call-handling, triage systems

Agreement by cluster team on operational models for call-handling, signposting, clinical triage systems

IT systems installed to support safe and effective call-handling / triage processes

Guidance and protocols in place for all cluster call-handling and triage systems

Training and refresher courses attended by all staff involved in cluster call-handling & triage systems / processes

Regular risk assessment & audits for all

Safe and effective cluster call-handling & triage systems in place to assist service users in accessing right information, advice & care from clinical and non-clinical services

Non-clinical referrals are assisted by link workers, social prescribers, care navigation, etc and citizens are signposted using the national Directory of Service

Robust protocols, guidance and support are in place for all cluster call-handling, signposting and triage systems

Service user feedback, monitoring, significant event analysis & audits inform redesign of systems

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cluster call-handling and triage systems

Regular refresher courses attended by staff delivering call-handling/triage services

111 and Out-of-Hours Care

Given that 111 is not fully rolled out across Wales, should 111 be separated from OOH – especially as 111 is

a 24/7 service whereas OOH isn’t?

Systematic patient feedback systems embedded in 111/GPOOH services Flexible boundaries to allow patients to be assessed in service closest to home (not where they are registered) Equitable access to emergency/urgent dental conditions in line with national specification Flexible workforce solutions that allow professionals to work remotely Consistent policies on management of home visits

OOH advice & care delivered by multi-professional team including core disciplines available to all services – eg. pharmacists, nurses, doctors, paramedics Standardised pathways for common issues – eg. management of blocked catheters, end of life care

Excellent communication systems across in- and out- of-hours interface with handover of care through effective sharing of ‘Special Patient Notes’ and Anticipatory Care Plans

OOH and 111 Staff have access to relevant, up-to-date records through Welsh GP Record

People effectively signposted to appropriate advice & care by use of MDT in OOH period, with potential for scheduling into alternative pathways (eg. community services ) by 111/GPOOH service without hand-off back to own GP

Specialist skills available during OOH period through regional working (eg. Mental Health Specialists) Use of digital technology to improve patient experience and efficient service delivery

Integrated pathways between 111/GPOOH and 999 service

People with Complex Care

Needs

People with more complex needs are identified by use of benchmarking, disease registers, risk stratification tools, admissions data, etc

Analysis of cluster professional capacity and skills to deliver complex care undertaken, e.g. GPwSIs, ACPs, Community Resource Team, Frailty Team, Integrated Health & Care team, specialist teams

Increased emphasis on disease

Multi-professional teams increase cluster capacity and tailor consultation times to the needs of more complex patients

Cluster Outreach Services deliver specialist care through an MDT approach, closer to home

Community diagnostic services support complex care closer to home

CRTs, Frailty and Integrated Health & Care teams support complex care through MDT approach within primary care / community settings

Virtual Wards and Community Hubs are used to care for acutely ill people, with hospital specialists working alongside cluster teams

Increased range of planned care delivered within the community, with local access to

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prevention for long term conditions in cluster community, using LPHT support / expertise, PNAs and PWBAs

specialist expertise and diagnostics

Infrastructure to support

Transformation

Good understanding by cluster team of infrastructure requirements for effective cluster working: estates & facilities, IT systems, community diagnostic services, etc.

Support and expertise is readily available to promote and support cluster working, e.g.

PNAs and cluster planning

Business case development

Data analysis, IT systems, new technologies

Cluster infrastructure scoped to identify development needs, with prioritisation

Appropriate channels, mechanisms and support are used to escalate significant deficiencies in cluster infrastructure, with clarity on risks to safe, effective cluster working

Where appropriate, business cases address deficiencies in infrastructure and facilities, e.g. community diagnostic services, smart technologies.

Local estates and facilities are fit for purpose, sustainable and support multi-professional team working and training

Informatics and telephony systems in place with designs that support and promote multi-professional working

Digital options that enable service users to access care quickly and easily are commonplace

Direct access to range of diagnostic services is available to cluster teams

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Resource Pack 4

Principles of Good Governance

The Health and Social Care Review

Align governance objectives with the new strategy for health and social care in Wales

Deliver the Quadruple Aim, aligned with the principles of the Wellbeing of Future Generations (Wales) Act, Prudent Healthcare and the Social Services and Well-being Act

Deliver improved outcomes via seamless health and care systems

Consider national, regional and cross-sector opportunities ahead of local concerns whenever appropriate

Assess their performance based on a common set of outcome indicators

Assess maturity against the Good Governance Institute’s Maturity Matrix and System Transformation Matrix as appropriate

Have proportionate and consistent oversight, regulatory and inspection arrangements, with consistent metrics, incentives, sanctions and intervention triggers. Assurance recommendations should be taken seriously, tracked and actioned (as emphasised by the Williams Commission Report on Public Service Governance and Delivery)

Be empowering and ensure effective leadership and transparent decision making at all levels with clear lines of accountability throughout

Adopt a continuous improvement approach, involving staff and service users

Embrace a ‘participative enterprise’ culture with closer involvement of staff, clinicians, service users and other key stakeholders, including primary care and third sector

Maintain a sharp focus on staff engagement and wellbeing, including addressing issues in Staff Survey results and medical assessment scale surveys

Have consistent annual effectiveness reviews overseen by an independent member, focussing on leadership and behaviours, operational performance and delivery of change

Ensure that their membership is sufficiently diverse, and that a successful background in change delivery, organisational development and behavioural science skills are well represented

Share successes and challenges with one another as part of a learning system that promulgates best practice and helps eliminate waste and unwarranted variation. This should include ‘exemplar’ Regional Partnership Boards

Be transparent regarding performance, and open to public and political scrutiny.

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Resource Pack 5

Example of Cluster Vision and Mission

1. Vision

The cluster has developed the following vision statement to describe the intended long-term ambitions of their collaborative model:

‘Improving patient outcomes by promoting the sustainability and resilience of GP Practices’

2. Mission

The cluster model’s mission demonstrates how it will achieve its vision. It is based on the

assumption that should the sustainability and resilience of GP Practices improve, this will have a

positive impact on patient outcomes, encourage innovative and integrated models of care, and

support staff recruitment and retention.

The diagram below demonstrates how the model’s various ambitions will result a range of benefits

that will enable the new model to achieve its vision:

3. Aims

3.1 While the in-scope GP Practices wish to explore the concept of a collaborative model, there is a desire to ensure that any new model does not jeopardise the independent contractor status of the individual GP Practices or the work of the GP Network Cluster. 3.2 The intention is for each in-scope GP Practice to have equal ownership and control of the new model, while it should be configured to benefit all GP Practices.

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3.3 The model is required to provide the GP Network Cluster with a means of implementing the GP Cluster Action Plan without requiring a GP Practice to act as the lead in relation to employing staff or entering into contracts.

3.4 The intention of the new model is not to take away existing GMS or enhanced service delivery

responsibilities from the in-scope GP Practices, rather to support the in-scope GP Practices to

deliver on these commitments, while also helping them to expand their service offering and relieve

pressure on GPs.

3.5 It is essential that the new model dovetails with existing arrangements, adding additional

capabilities and capacity, rather than in any way impeding the work of the individual GP Practices

or GP Network Cluster.

The diagram below demonstrates the intended positioning of the collaborative model:

North Ceredigion Locality (HDUHB NHS Wales intranet) PCOne North Ceredigion Locality

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Resource Pack 6

Key elements to consider when forming a Cluster / Federation

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Inquiry into Primary care Clusters 2017

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Resource Pack 7

Cluster Option Appraisal (Sample)

Once the assessment criteria are developed, each is assigned a weighting (high/medium/low) to

demonstrate their level of importance.

Of the criterion that were considered of high level importance, several are assigned ‘gateway

criteria’ status – meaning that if a long-listed option cannot satisfy the requirement, it cannot

progress to the short list of options. Full details of the assessment criteria and scoring

mechanism are provided below:

Weighting

Gateway

High score (10 pts) Medium

score (5 pts)

Low score (0 pts)

Desirability : Ability of new model to…

1.1 Maintain individual GP Practice

independent contractor status /

autonomous decision making

H Y Option enables each GP

Practice to maintain

their independent

contractor status and

ability to make

autonomous decisions

N/A Option does not enable

each GP Practice to

fully maintain their

independent contractor

status and ability to

make autonomous decisions

1.2 Employ staff directly H Y Option enables the model to direct employ staff

N/A Option does not enable the model to direct employ staff

1.3 Enter into formal contracts with third parties

H Y Option enables the model to enter into contracts with external third parties

N/A Option does not enable the model to enter into contracts with external third parties

1.4 Influence LHB and LA policy/decision

making through a collective voice

H Option will lead to the

creation of an

incorporated body that

provides the opportunity

for all GP Practices to be represented equally

N/A Option will not lead to

the creation of an

incorporated body

that provides the

opportunity for all GP Practices to be represented equally

1.5 Maintain strong links with external

stakeholders (e.g. patients, VCS

organisations etc.)

M Option allows for

external (out of scope)

stakeholders to play a

role in the ownership

and/or governance of the new model

N/A Option does not allow

external (out of scope)

stakeholders to play a

role in the ownership

and/or governance of the new model

Viability: Ability of new model to…….

2.1 Directly enter into agreements regarding

a range of LHB/NHS funding (GMS,

Section 50 etc).

H Y Option enables the model

to enter directly into

GMS/Section 50

contracts

Option enables the

model to enter into

GMS/Section 50

contracts as a sub-

contractor

Option does not enable

the model to enter into

GMS/Section 50

contracts, or become a

sub-contractor in such agreements

2.2 Provide flexibility re use of surpluses,

including (in the long term) profits

being distributed to GP Practices to

support their Sustainability and

resilience

H Option allows for

surpluses to be

distributed to the

individual GP Practices that own the model

N/A Option does not allow

for surpluses to be

distributed to the

individual GP Practices that own the model

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Feasibility: Ability of new model to…….

3.1 Achieve the required pensionable status

H Option enables the new

model to achieve the

required level of

pensionable status,

allowing staff to continue

to contribute to their existing NHS Pension scheme

N/A Option does not

enable the new model

to achieve the required

level of pensionable

status, not allowing staff

to continue to

contribute to their existing NHS Pension scheme

3.2 Flexibly allocate staff and manage resources across the Cluster

H Option enables (via its

inherent

characteristics) the

ability for GP Practices to

allocated staff/manage

resources across the

Cluster

Option provides

some scope (via its

inherent

characteristics)

for GP Practices to

allocated

staff/manage

resources across

the Cluster

Option does not

demonstrate the

ability (via its

inherent

characteristics) for GP

Practices to allocated

staff/manage resources across the Cluster

3.3 Establish formal links with other Clusters and GP Practices

M Options promotes (via its

inherent characteristics)

links with other Cluster

s and GP Practices

Options provides

some/limited

scope (via its

inherent

characteristics) for

links with other

Cluster s and GP

Practices to be established

Options provides no

scope (via its inherent

characteristics) for

links with other Cluster

s and GP Practices to be

established

3.4 Allow for GP Practices to join/leave over time

M Option provides a flexible

ownership structure that

allows GP Practices to

either become part of or

leave the model's

ownership and/or governance structure

N/A Option does not

provide a flexible

ownership structure

that allows GP Practices

to either become part of

or leave the model's

ownership and/or governance structure

3.5 Establish by April 2017 (preferred timescale)

M Option can realistically become operational on 1st April 2017

N/A Option cannot realistically become operational on 1st April 2017

BMA Salaried GPs working under new models of care RCGP Primary Care Federations putting patients First Kings Fund Toolkit to Support the Development of Primary Care Federations

Following the options appraisal stage, two important stages are required to ensure the

establishment of a viable and sustainable organisation – business planning and transition. The

journey to establishment is summarised in the diagram below, along with the indicative dates

relating to this project.

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Resource Pack 8

Cluster Voting System (Sample)

Memorandum of Understanding for Cluster

1. 1 vote per practice (PM or GP can represent the practice at a meeting).

2. Minimum number of practices represented at a meeting to enable vote to be taken = 6

3. Aim for consensus, but 6/8 votes needed if consensus cannot be achieved.

4. Health board representative will vote on behalf of a managed practice.

5. Encourage contributions and actively engage with other members of the wider Cluster team, seeking their opinions and support for projects and initiatives, eg public health, community nursing, community pharmacists, optometrists, dentists, third sector and any other organisation providing services to our population.

6. Practices may opt out of a Cluster initiative if they wish.

7. Any Cluster initiative should include a minimum of two practices.

8. GP Cluster Lead will chair the meetings. In their absence or if there is deemed to be conflict of interest the Cluster can appoint another member to chair.

9. LDM takes minutes. Action points will be circulated to all Cluster members prior to the next meeting.

10. This memorandum of understanding will be reviewed annually and amended to reflect the evolving nature of Cluster and Cluster working.

Memorandum of Understanding Version 1: Date Review date: Date ……………………Partnership

Surgery Signed: ______________________________________ Print Name: ______________________________________

Surgery Signed: ______________________________________ Print Name: ______________________________________

Surgery Signed: ______________________________________ Print Name: ______________________________________

NB Check these … ABMUHB MOU BCUHB MOU C&VUHB MOU CTUHB MOU HDUHB MOU PTHB MOU

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Resource Pack 9

Risk Management Guidance

NHS Wales governance e-manual Risk Management ABM UHB Risk Management Report Aneurin Bevan Risk Management Strategy and Processes BCUHB Risk Management Policy and Strategy C&V Risk Assessment and Risk Register Procedure Cwm Taf Risk Management Policy HDUHB Risk Management Policy and Strategy Powys THB Risk Assessment Policy

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Sample Risk-scoring matrix

http://www.hse.gov.uk/risk/faq.htm ABMUHB Risk Register Corporate Aneurin Bevan Risk Register Corporate BCUHB Risk Register Corporate C&VUHB Risk Register Cwm Taf UHB Risk Register Organisational HDUHB Risk Register Template Powys THB Risk Register Information Governance C&VUHB Risk Scoring & Matrix HDUHB Risk Scoring Matrix ABMU Risk Management Strategy ABUHB Risk Management Strategy and Processes BCUHB Corporate Risk and Assurance Framework C&V UHB Risk Management Framework C&VUHB 5 Steps to Risk Assessment Cwm Taf Risk Management Policy Cwm Taf Quality, Safety & Risk Committee HDUHB Risk Management Framework PTHB Risk Report

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Resource Pack 10

What does (or could) influence decision-making in clusters? Cluster skills workshops on “Using evidence & evaluation in cluster action plans” were delivered during October 2017 by the Primary Care Hub team, with support from Observatory Evidence Service and Knowledge Mobilisation staff. Three regional workshops took place for audiences comprising cluster support staff; cluster development managers and those in similar roles; and local public health team staff who support primary care colleagues. Each workshop provided an overview of finding and appraising evidence; prioritising cluster actions; and evaluation in theory and practice. The session on factors influencing prioritisation indicated that “evidence” is but one of many variables that does (or could) influence cluster decision making. The collated contributions of workshop participants are provided below.

1. Business case

Evidence base

• Relevant local data on needs • Voiced community wants/ needs • Degree of certainty over best intervention • Agreement on interpretation of evidence • Opportunity to generate evidence (“ideas leading to evidence cf. evidence directing ideas”) • Sharing of local best practice/ experience • Evaluation of current schemes esp. evidence of sustainability • Anecdotal evidence of clinical endorsement • Evidence gaps (as a barrier or change facilitator)

Benefits anticipated

• For patients • More satisfaction • Better outcomes • Optimised access • Care closer to home

• For GP/ GP practice • For community (incld. use of assets) • GP workload/ demand reduction • Reduction in secondary care use • Reduction in medication use • Sustainability impact • Prevention opportunities • Improved integration • Collaborative working • Reduced duplication

2. Partnership

Cluster

• Personalities • Diversity of GP practices (needs, resources, business state) • Agreement

• Between GPs • Between practices

• Local expertise/ experience • Stability/ fragility • Fit with existing plan/ priorities • Herd mentality/ peer pressure

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Community

• Wants/ needs voiced

Health board

• Restrictions/ barriers • Policies & procedures • Strategic priorities

Public health

• Local public health team advice • LPHT need to “do” not just “tell” as partners • Wider strategic alignment

Public service board

Welsh Government

• Targets/ policy imperatives • Voluntary vs. mandatory • Politics of topicality/ policy “buzz”

Politics, politics, politics

Competing priorities

Healthy & trusting relationships

3. Process-related

• Maturity as an entity • Existence (or not) of a decision-making methodology e.g. “loudest voice” • Formality vs. informality of meetings • Locus of power/ control • Engagement process, inc. opportunities to challenge & recognition of historic problems • External process dependencies e.g. procurement, recruitment & employment • Lack of systematic approach to assessing cost-benefit • Information governance barriers • Contracting barriers, inc. currency, flexibility

4. Implementation

Feasibility

• Primacy of maintaining front-line services • Effort/ ease of implementation • Quick wins • Tick-box exercise • Simplicity/ adaptability • Ease of monitoring data/ gaps in data esp. flow btw primary & secondary care • Shared ownership vs. “agreement” • Understanding of local context e.g. new housing development • Previous “change” experience • Extent to which team already integrated • Ease of changing existing attitudes/ cultures • Timing e.g. in relation to service impacts of big sports events

Resources

• Time

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• Staff • Capacity (time) • Capability (skills/ experience, inc. practice-level leadership) • Agreed responsibilities • Impacts on wider team/ day-to-day operations • Impacts on morale • Ease of recruitment (or need to find alternatives)

• Equipment needed • IT barriers

• Suitability of premises/ building constraints • Finance

• Free/ no implementation cost • Pressure to spend (fiscal) esp. in Q3/4 • Financial boundaries/ independence to act • Funding constraints (year-on-year, short timescales) • Sponsorship/ other external funding, inc. drug companies • Offer of resources/ assets • Slow money flow/ funds outstanding • Potential for financial gain or loss • Value for money • Cost-benefit • Opportunity cost • GMS contract (inc. QoF)/ financial incentives • Self-interest/ profitability

Risks

• Mitigation requirement • Media interest/ reputational risk • Competing priorities/ existing realities • Viability if non-recurrent funding • Perceived threat to secondary care services • Innovation involves risk cf. relative safety of familiarity

5. Leadership

• Interest/ energy/ enthusiasm • Pet project/ personal agendas • Legacy • Personality • Integrity/ credibility • Impact of cluster lead (inc. any linked governance issues) • Recognition of good will

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Resource Pack 11

Cluster Terms of Reference (Sample)

Terms of Reference (TOR) provide a statement of the background, objectives, and purpose of a project or development of a cluster. The following template is a starting point to create a cluster. Terms of Reference can be changed to suit the specific needs of the cluster. They include a range of criteria that are necessary for strategic cluster decision-making and provide an overview of the key sections of a TOR document.

Add Cluster Name

Terms of Reference

Version

No. Author Issued to Date Comments /

Changes applied

Review Date

V0.1 CD Leads / Cluster

Managers/ PCIC CD & Director

Draft for consideration by Clusters

Contents

4 Introduction 5 Membership 6 Role of individual group members 7 Business/Meeting Arrangements 8 Purpose & Duty Statement 9 Reporting & Assurance Arrangements 10 Review 11 Signatures

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1. Introduction

It is the function of the Cluster to: add a brief description on the key driver(s) for Cluster development and implementation. Include background information on both the WG papers and UHB papers, e.g. 1. C&VUHB Shaping our Future Wellbeing Strategy (2015-2025) 2. Our Plan for a Primary Care service for Wales up to March 2018, Welsh Government, Nov 2014 3. A Planned Primary Care Workforce for Wales – approach and development action to be taken in

support of the plan for a primary care service in Wales up to 2018, Welsh Government 4. Social Services & Well-being Act 2014, part 2 section 16 5. Well Being & Future Generations Act 2016 6. QOF Section 2.3: Summary Cluster Network Domain Any other information that may be of use to the Cluster membership.

2. Membership

2.1 The membership of the Group shall comprise of the following:

Other members may be included as required. 2.2 Membership of the Committee will be reviewed on an annual basis.

Member [to be discussed and agreed locally]

Cluster Lead

Nominated clinical lead (where the Cluster lead is not a clinician)

Practice Manager Lead

Cluster Development Manager

County Director / Leadership member

Clinical & managerial representation from Cluster GP Practices [list each practice on a separate line]

Community Pharmacy Lead

Community Optometry Lead

General Dental Lead

Local Authority Lead

Third Sector Broker / Lead

Community Health Council / Patient Representative

In Attendance

Public Health Wales

Finance

IM&T

Medicines Management

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3.1 A quorum shall consist of no less than [to be agreed locally].

3.2 Any senior officer or clinician of the UHB or partner organisation may, where appropriate, be invited to attend, for either all or part of a meeting to assist with discussions on a particular matter.

3.3 It is expected that Cluster members will reach consensus decisions where possible. All

significant decisions relating to Cluster priorities and funding will be documented and a fair and democratic approach to decision making will be undertaken. Where a consensus decision is not reached the following voting scheme will be utilised [to be amended according to local discussion]

3.3.1 Each Member listed above has ONE vote. 3.3.2 For decisions where there is NO financial implication, a majority vote (50% + 1) will

secure the decision. 3.3.3 For decisions where there is a financial implication, no less than 75% of members will

secure a decision. 3.4 Declarations of interest should be openly recorded and considered when decisions are made.

Individual members may be asked to abstain from particular decisions where appropriate.

3. Responsibilities of individual group members

The responsibilities of the individual member of the (insert name) Cluster include: 3.1 Attending regular Cluster meetings as required six times per year and actively participating in

the cluster work programme 3.2 Representing the interest of all Cluster member employees, as appropriate 3.3 A genuine interest in the initiatives and the outcomes being pursued in the Cluster 3.4 Being an advocate for the Cluster outcomes 3.5 Being committed to and actively involved in pursing the Cluster outcomes

4. Business/Meeting Arrangements

4.1 The Cluster CD Lead, in discussion with the Cluster Manager and/or Practice Manager Lead,

shall determine the need for additional interim meetings in order to make timely decisions. Alternatively the Lead may decide that a decision can be made virtually, confirmed by Cluster Lead action.

, 4.2 A quorum shall consist of representatives of no less than x GP Practices. 4.3 Any senior officer or clinician of the UHB or partner organisation may, where appropriate, be

invited to attend for all or part of a meeting to assist with discussions on a particular matter.

3. Quorum and Attendance

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4.4 It is expected that Cluster members will reach consensus decisions where possible. All significant decisions relating to Cluster priorities and funding will be clearly documented and a fair and democratic approach to decision making undertaken. Where a consensus decision is not reached, the following voting scheme will be utilised:

o Each Member listed above has ONE vote.

o For decisions with NO financial implication, a majority vote x will secure the decision.

o For decisions where there is a financial implication, no less than ? of members will

secure the decision. 1.1 Declaration of interest should be openly recorded and considered when decisions are made.

Individual members may be asked to abstain from particular decisions where appropriate.

1.2 The Cluster Manager and/or the Practice Manager Lead and /or Project Support Officer will support the administration and provide secretarial support to the meeting.

1.3 The Cluster Manager and/or the Practice Manager Lead and /or Project Support Officer will

liaise with the Cluster CD Lead and the membership of the group to set each agenda. 1.4 The agenda and papers for meetings will be distributed a minimum of ? days in advance of the

meetings. 1.5 The minutes / action log / decision log / dashboard will be circulated to members within x days

to check the accuracy. 1.6 Minutes to be approved at next meeting.

5. Purpose & Duty Statement Otherwise known as roles and functions, which need to be worked through and agree at Cluster meeting. The Terms of Reference should include:

The reasons for Cluster development (current purpose, objectives and intended outcomes including key output, outcomes and impact indicators)

What it intends to accomplish including the history of the Cluster and how the outcomes have changed

How it will be accomplished; maybe include a Cluster PESTLE / SWOT analyses (see App 1&2)

Who will be involved in the evaluation

When milestones will be reached and when

What resources are available to support Cluster development, both resources and financials

Communication

Sustaining core GMS / primary care services

Local Health needs approach

Integration of local services

Quality Improvement

Service delivery

Extended service delivery

Informing the planning / delivery of secondary care services

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Could include something along the lines of:

Provide strategic leadership in the development, implementation and sustainability of health and wellbeing programs and strategies within the Cluster.

Provide advice, support and assistance in the implementation of the program and projects within.

Assist in the promotion of Cluster development.

Monitor identified and emerging risks and advise on their prevention, mitigation and management.

Recognise barriers and enablers to Cluster development and assist in developing initiatives to address these

Identify local population needs

Monitor Cluster trends in the health and wellbeing of the local population

Monitor the Cluster budget and expenditure Insert any additional roles/functions as necessary avoiding a lengthy list of objectives. Use clear outcome-focused language.

6. Reporting & Assurance Arrangements

6.1 The CD lead and the Cluster Manager will report on the Cluster Plan and delivery of the

priorities within it via the Primary Care CD Forum. 6.2 The Cluster Plan to be developed, where possible, by x and submitted for approval to the

Health Board’s Primary Care Team. 6.3 The Annual Report, including outcomes against the Cluster Plan to be completed no later than

x and submitted to the Health Board’s Primary Care Team for review.

7. Review

7.1 These terms or reference and operating arrangements shall be reviewed on at least an annual basis.

8. Signatures

Signed by Cluster CD Lead: ……………………………………………………… Date: …………………………………………………………………………………

App 1

A PESTEL analysis is a framework or tool used to analyse and monitor external environmental

factors that have an impact on an organisation. The result is used to identify threats and

weaknesses, as used in a SWOT analysis.

PESTEL stands for:

P – Political E – Economic S – Social T – Technological E – Environmental L – Legal

The impact of political, economic, socio-cultural, environmental and other external influences Health Knowledge Exercise PESTEL Business Wales

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App 2

A SWOT analysis is strategic planning technique that can help an organization identify the Strengths, Weaknesses, Opportunities, and Threats related to project planning. It is intended to specify the objectives of the project and identify internal and external factors that are favourable and unfavourable to achieving those objectives.

Users of a SWOT analysis often ask and answer questions to generate meaningful information for each category. Strengths and Weakness are usually internally related, while Opportunities and Threats focus on environmental factors.

1. Strengths: characteristics of the project that give it an advantage 2. Weaknesses: characteristics of the project that place it at a disadvantage 3. Opportunities: elements in the environment that the project could exploit to its advantage 4. Threats: elements in the environment that could cause trouble for the project

Standards and Guidance for Role Redesign in the NHS in Wales

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Resource Pack 12

Terms of Reference for Cluster Leadership Group (Sample)

It is the function of the Cluster to: 1.1 Plan services and engagement with local providers and users of services to :

Develop local plans based on assessment of local need

Further develop local needs assessment working closely with colleagues in public health and

developing a shared understanding of priorities across health and social care services

As a collective influence the Health Boards priorities identified in the IMTPs.

Develop more effective engagement with the population to strengthen the arrangements to

respond to the views of patients and service users

1.2 Support and further develop Multi-disciplinary Team Working / Integration :

Ensure the sustainability of core services with appropriate risk management and actions to

address local needs, including improved access to services.

Provide mutual support and peer review, e.g. to reduce variation or to address sustainability

challenges

Strengthen the multidisciplinary team working and inform local workforce strategies

Further develop horizontal integration to support sustainable general practice and new models

of care led by local teams (for example developments may include cross referral for clinical

care; federations of GP practices; shared administrative support; full practice mergers

Develop more effective collaborative working with community services (including nursing, local

authority and third sector) to improve the communication, coordination and quality of care and

to optimise the availability of professional skills.

1.3 Review and develop new pathways and models for improved service delivery :

To continue and develop the Cluster Network actions from previous years where appropriate

Prioritise signposting to the most appropriate professional or self care

[NAME OF CLUSTER] CLUSTER LEADERSHIP / GROUP MEETING

Version Issued To Date Comments

V0.1

V0.2

V0.3

V0.4

1. Introduction

35

2.1 The membership of the Group shall comprise of the following:

3.4 A quorum shall consist of no less than [to be agreed locally].

3.5 Any senior officer or clinician of the UHB or partner organisation may, where appropriate, be

invited to attend, for either all or part of a meeting to assist with discussions on a particular matter.

3.6 It is expected that Cluster members will reach consensus decisions where possible. All

significant decisions relating to Cluster priorities and funding will be documented and a fair and democratic approach to decision making will be undertaken. Where a consensus decision is not reached the following voting scheme will be utilised [to be amended according to local discussion]

3.3.1 Each Member listed above has ONE vote. 3.3.2 For decisions where there is NO financial implication, a majority vote (50% + 1) will

secure the decision. 3.3.3 For decisions where there is a financial implication, no less than 75% of members will

secure a decision. 3.4 Declarations of interest should be openly recorded and considered when decisions are made.

Individual members may be asked to abstain from particular decisions where appropriate.

2. Membership

Member [to be discussed and agreed locally]

Cluster Lead

Nominated clinical lead (where the Cluster lead is not a clinician)

Practice Manager Lead

Cluster Development Manager

County Director / Leadership member

Clinical & managerial representation from Cluster GP Practices [list each practice on a separate line]

Community Pharmacy Lead

Community Optometry Lead

General Dental Lead

Local Authority Lead

Third Sector Broker / Lead

Community Health Council / Patient Representative

In Attendance

Public Health Wales

Finance

IM&T

Medicines Management

3. Quorum and Attendance

36

To develop a set of Cluster population health priorities which are then articulated annually into a

Cluster Plan.

The Cluster Plan to be finalised no later than date.

The Cluster Funding Plan to be developed, where possible, by date.

To submit the Cluster Funding Plan for ‘light touch’ approval to the Health Board’s Primary Care

Sub-Committee.

To deliver the agreed actions contained within the Cluster Plan and the Cluster Funding Plan.

To complete an End of Year Report, including outcomes against the Cluster Plan and the Cluster

Funding Plan, no later than date.

To monitor utilisation of the Cluster Fund, with support from Health Board finance teams.

To consider, as part of the Cluster Plan and Cluster Funding Plan, the holistic needs of the

population.

To be accountable for achieving best value within their Cluster Fund and to achieve financial

balance with funds allocated.

To recognise that contractors are different and should facilitate providers to be able to engage with

the Cluster work programme.

5.1 The Cluster Development Manager and/or the Practice Manager Lead will support the

administration of the Meeting.

5.2 The Cluster Development Manager and/or the Practice Manager Lead will liaise with the Cluster Lead and the membership of the group to set each agenda.

5.3 The agenda and papers for meetings will be distributed x days in advance of the meeting.

5.4 The minutes and action log will be circulated to members within x days to check the accuracy.

5.5 Members must forward amendments to the Cluster Development Manager and/or the

Practice Manager Lead within the next x days.

6.1 The Meeting will be held [add in the frequency of the meetings...bi-monthloy suggested]. 6.1.1 [add in here the months of the meetings or dates if you can for annual review] 6.2 The Cluster Lead, in discussion with the Cluster Development Manager and/or the Practice

Manager Lead, shall determine the need for additional interim meetings in order to make timely decisions, or determine whether these decisions can be made virtually and confirmed by Cluster Lead action.

4. Purpose

5. Agenda and Papers

6. Frequency of Meetings

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7.1 The Cluster Leads will attend Bi-monthly Cluster Development Network Meetings and will

report on the Cluster Plan, Cluster Funding Plan and delivery of the priorities within it.

7.2 The Cluster Funding Plan to be developed, where possible, by the date and submitted for ‘light

touch’ approval to the Health Board’s Primary Care Sub-Committee.

7.3 The End of Year Report, including outcomes against the Cluster Plan and the Cluster Funding

Plan, to be completed no later than 31st March and submitted to the Primary Care Sub-Committee

for review.

8.1 The Cluster Development Manager and/or the Practice Manager Lead will provide secretariat

support for the meeting.

9.1 These terms of reference and operating arrangements shall be reviewed on at least an

annual basis.

ABM UHB TOR Quality & Safety Committee Aneurin Bevan TOR Operating Arrangements Betsi Cadwaladr TOR Quality & Safety Committee C&V TOR Regional Partnership Board Cwm Taf TOR Primary and Community Care Committee Hywel Dda TOR Primary Care Applications Committee Powys TOR Quality & Safety Committee

7. Reporting

8. Secretarial Support

9. Review Date

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Resource Pack 13

Project Prioritisation Framework (Sample)

Cardiff City & South Locality

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Resource Pack 14

Integrated All-Wales Primary Care Needs Assessment

Situation analysis

1.1 Where do we want to be?

Acceptance that healthcare is best organized at small population level was a basis for creating 64 clusters

in Wales, each serving 30–50k registered GP practice populations, to permit joint working on development

of services

To achieve this, cluster plans should be informed by evidence of population needs & evidence on

effective interventions

This in turn is contingent upon overcoming major sustainability pressures contributing to health needs

assessment capacity & capability constraints

1.2 Where are we now?

Cluster end user issues:

A number of intelligence providers may each offer a variety of products; navigating this myriad of

offerings to find the information you want can be intimidating

Multiple products create information overload & don’t offer a single source of truth

A GP/ clinical focus is understandable, yet wider primary care, well-being & wider determinants also

impact population health status

Health board/ local public health team (LPHT) user issues:

It’s not possible to compare one cluster needs assessment to another (or track improvements across

time) without some standardisation

Cluster plans may lack reference to evidence on interventions explicitly linked to needs

LPHTs have adopted a ‘hunter-gatherer’ role, sourcing what data are obtainable or traditionally

provided, in the absence of widespread agreement on what is actually needed

Intelligence provider issues:

Some products come out too late to inform cluster plans; timings may need adjustment

Limited assurance on whether individual products are used to inform decision making

Products utilised in silo, with limited cross-provider data integration to tell a coherent story

Systems working issues:

Lack of a shared needs assessment/ solutions process inhibits alignment of priorities across clusters,

health boards, Public Health Wales & Welsh Government, with examples of existing effective practice

not visible at the point of decision making

The duplication of effort involved in 64 disparate needs assessments/ 7 LPHT supporting activities is

an inefficient use of limited capacity resource & creates unhelpful variation

Existing cluster & LPHT capability solutions may not fully reflect the optimal contribution these roles

can make to the needs assessment process (e.g. periodic workshop attendance may not translate to

ability to undertake robust needs assessment)

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Project plan

• Aim

Integrated All-Wales Primary Care Needs Assessment (IAWPCNA) will support evidence-informed

cluster planning & increased strategic alignment to help drive quantifiable cluster population health

improvements. It will do this through: (1) integration of data sources reflecting wider primary care and

covering prioritized health status/ service use indicators, effective intervention options, local

implementation/ quality/ safety lessons; (2) offering an easy-to-use assessment-orientated front end;

and (3) by utilising once-for-Wales templates to effect standardisation by place & time, & to minimise

duplication of effort.

• Project overview

A visual overview of timings, activities and products by project stage is given in Fig. 1

Timings aspire to support operational use within the 2019/20 cluster planning cycle

Fig. 1: IAWPCNA 4-stage overview; an initial commitment is requested to Stage 1 only, recognizing the importance of utilising meaningful engagement with primary care to design subsequent stages

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2.3 Stage 1 objective, activity & product

Objective: reach national agreement on the components of IAWPCNA via engagement

Activity: engagement workshops

Output: written agreement on IAWPCNA components

Stage 1 is detailed further below (section 4)

2.4 Stage 2 objective, activity & products

Objective: agree database specifications, including ongoing resource requirements

Activity: database specification, which is likely to involve additional engagement

Outputs: databases (and curation processes) for health status/ service use indicators (metrics);

evidence statements on effective intervention options by indicator group; synopses of learning from

local implementation/ best practice; & potentially synopses of learning from quality improvement activity

or patient safety issues where applicable

2.5 Stage 3 objectives, activity & product

Objectives: design a front end/ portal; implement & refine this via user feedback; formally launch

IAWPCNA

Activities: portal design (coding/ web development); end user testing; launch planning

Output: an easy-to-use portal to support cluster plan preparation

2.6 Stage 4 objectives, activity & product

Objectives: evaluate IAWPCNA following the first utilisation cycle; transition to a sustainable model for

ongoing maintenance & development responsibility

Activity: negotiation of project handover

Output: end-of-project evaluation report to guide ongoing development within business-as-usual in the

care of an appropriate sponsor

Anticipated project benefits

Benefits to clusters:

Focuses on the key deliverable (needs assessment), not on individual intelligence products (cluster

can remain provider/ product naïve)

Compatible with a disease pathway approach that is familiar to clinicians & emphasises the primacy of

prevention; also allows integrated consideration of wider determinants data

Creates an explicit link between evidence on needs & evidence for responsive action

Facilitates the joining up of population health (e.g. PHW) & healthcare public health (e.g. LHB)

intelligence to tell a coherent story

Incorporation of analysis based on individual-level data (via Audit+) should enable assessment of co-

morbidities (rather than examine conditions in isolation, as is traditional)

Benefits to public health teams:

Refines the LPHT value-added contribution to interpretation/ prioritisation assistance via a structured

conversation around the needs assessment (LPHT don’t have to provide the data)

Releases LPHT capacity to assist clusters with any local assessment topics beyond IAWPCN

42

Benefits to health boards:

Ensures cluster plans are informed by data/ assessments reflecting wider primary care

Templating provides a measure of quality assurance that may be difficult to replicate within one-off

unstructured needs assessments

Templating permits a baseline to spot variation between clusters & across time (including monitoring

plan effectiveness in improving population health)

Benefits to health intelligence providers:

Should IAWPCNA not progress beyond Stage 1, engagement still informs product development/ new

product priority

National agreement increases the likelihood that data products feeding into IAWPCNA would be better

aligned to cluster planning cycle timeframes

Benefits to the wider system/ systems working:

As clusters are at different stages of maturity, IAWPCNA can help normalise consideration of data

through a holistic lens (e.g. well-being, wider primary care, wider determinants)

A once-for-Wales template maximises efficiency by making the most of each party’s value-added

contribution

Shared underlying health intelligence provision and a shared process for sifting evidence on best-value

interventions positions LPHTs and Primary Care Support Units to help bring alignment to health & well-

being goals & to encourage synergistic health improvement approaches at various levels

IAWPCNA can enhance visibility of whole-system concerns e.g. antimicrobial resistance

For more information on primary care health intelligence

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Resource Pack 15

Integrated Impact Assessment

1. What is an Integrated Impact Assessment?

Integrated Impact Assessments (IIA) are used to support the scrutiny process of a Board or Committee by identifying the impacts of key areas of action before any strategic or higher level decisions or recommendations are made. It is recognised that certain proposals or decisions will require a wider consideration of potential impacts, particularly those relating to service change or potential major investment.

2. When is an Integrated Impact Assessment required?

Completion of the impact fields described within an SBAR reporting template (Situation, Background, Assessment, Recommendations) may suffice for most Board discussion and information items (see Appendix x). However for decisions to be made by the Board, the following impact fields of the SBAR often require careful consideration to assess the risks to quality & safety, financial impacts, etc:

Financial/Service

Quality/Patient Care

Workforce

Risk

Legal

Reputational

Privacy

Equality Where potential risks or impacts are identified, completion of the relevant section of an Integrated Impact Assessment template can accompany the SBAR, providing a response to the questions raised. A full Integrated Impact Assessment may be needed for strategic or higher level decisions or recommendations made by the Board and its Committees. BCUHB integrated impact assessment Integrated Impact Assessment Tool HDUHB Integrated Impact Assessment Tool HDUHB Do you need and integrated impact assessment The Integrated Impact Assessment Screening Toolkit Version 10 BMA-GPC Wales Briefing on Health Impact Assessments (HIA) Welsh Health Impact Assessment Support Unit (WHIASU)

44

Resource Pack 16

Equality Impact Assessment What is Equality Impact Assessment (EqIA)? Public Sector bodies have a legal duty to undertake equality impact assessment as a requirement of race, gender and disability equality legislation. EqIAs provide a systematic way of ensuring that legal obligations are met and are a practical means of examining new and existing policies and practices to determine what impact they may have on equality for those affected by the outcomes. The need for collection of evidence to support decisions and for consultation mean that the most effective and efficient EqIA is conducted as an integral part of policy development, with the EqIA commenced at the outset. The Toolkit (see link below) considers the effects that decisions, policies or services have on people on the basis of their gender, race, disability, sexual orientation, religion or belief, age, Welsh language and human rights. Assessing impact across a broad range of equality dimensions (not just those required by law), helps organisations to embed equality and human rights and assist them in the delivery of their services.

In the long term, it is hoped that equality and human rights considerations will be incorporated into other multi-functional impact assessment tools. Organisations may decide to do this locally, but must ensure that they meet all the requirements of the relevant legislation. In the meantime, EqIA is in its infancy and is a developing process. There is no single right way to carry out EqIA, but there is a balance to be struck between assessments that are overly complex and those that are too superficial. Initially the process may seem cumbersome and individuals undertaking EqIA may lack confidence in their skills and knowledge. However, over time (as with health and safety risk assessments), undertaking EqIA will become more routine and a body of knowledge, shared good practice and evidence to inform the process will be developed. Building elements of EqIA into the responsibilities of mainstream functions will assist organisations to mainstream equality and human rights. For example:

Patient and Public Involvement (PPI) leads should be fully involved in EqIA and take responsibility for parts of the process that require engagement, involvement and consultation

Information Management and Technology (IM&T) Departments should develop mechanisms to support data collection and analysis to include equality dimensions

Planning and Performance Departments should be responsible for the integration and alignment of all equality action plans with other operational and strategic plans

Clinical Governance leads and risk managers will have key roles to play in the EqIA process. Finance and service managers should use EqlA to ensure decisions about funding allocations and efficiencies are made in accordance with the requirements of the public sector equality duties.

A Toolkit for carrying out Equality Impact Assessment

Equality Impact Assessment in Wales Practice Hub

Equality Act 2010 (Statutory Duties) (Wales)

45

Resource Pack 17

Privacy Impact Assessment

Any new project that involves the potential use of person/ patient identifiable data must involve the Information Governance Lead at the outset. Where the project involves patient information, the Caldicott Guardian must also be involved. Part of the formal process must be the privacy impact assessment that identifies any areas of concern in relation to the identifiable information.

The Information Commissioner has developed a Privacy Impact Assessment (PIA) handbook that will assist organisations to ensure that privacy concerns and safeguards are addressed and built in as a project or system develops. The handbook can be found externally via the Information Commissioner's website and gives full and explicit details about why and how to conduct a full or small scale privacy impact assessment, and Data Protection compliance.

Privacy impact assessments are not mandatory but are increasingly being required under government policy (outcome from O' Donnell report following Her Majesty's Revenue and Customs data losses), providing a mechanism to manage project risk in the crucial area of public confidence.

Below is an overview of the Privacy Impact Assessment process derived from the Information Commissioners website:

Initial assessment -Examines the project at an early stage, identifies stakeholders, makes an initial assessment of privacy risk and decides which level of assessment is necessary.

Full-scale PIA-Conducts a more in-depth internal assessment of privacy risks and liabilities. Analyses privacy risks, consults widely with stakeholders on privacy concerns and brings forward solutions to accept, mitigate or avoid them.

Small-scale PIA-Similar to a full-scale PIA, but is less formalised. Requires less exhaustive information gathering and analysis. More likely to be used when focusing on specific aspects of a project

Privacy law compliance check-Focuses on compliance with various "privacy" laws such as HRA, RIPA and PECR as well as DPA. Examines compliance with statutory powers, duties and prohibitions in relation to use and disclosure of personal information.

Data protection compliance check-Checklist for compliance with DPA. Usually completed when the project is more fully formed.

Review and redo-Sets out a timetable for reviewing actions taken as a result of a PIA and examines their effectiveness. Looks at new aspects of the project and assesses whether they should be subject to a PIA.

It is acknowledged in the Information Commissioner's Handbook that the amount of detail in a PIA can vary considerably, dependant on the system that is proposed and the extent of the privacy impact and resulting project risk. On this basis organisations are encouraged to develop a PIA process that meets their particular needs.

Privacy Impact Assessment Wales (NWIS)

46

Resource Pack 18

SBAR Template (Sample 1)

CYFARFOD BWRDD PRIFYSGOL IECHYD UNIVERSITY HEALTH BOARD MEETING

DYDDIAD Y CYFARFOD: DATE OF MEETING:

TEITL YR ADRODDIAD: TITLE OF REPORT:

CYFARWYDDWR ARWEINIOL: LEAD DIRECTOR:

SWYDDOG ADRODD: REPORTING OFFICER:

Pwrpas yr Adroddiad (dewiswch fel yn addas) Purpose of the Report (select as appropriate)

Choose an item.

ADRODDIAD SCAA SBAR REPORT

Sefyllfa / Situation (N.B. 1 or 2 Paragraphs Maximum): - Why is this being brought to the Board’s attention? - What is the Board being asked to do? (cross-reference with guidance on Board action in

Recommendation Section below).

Cefndir / Background - Summary - Issues of significance to the Health Board - National / local objectives involved

Asesiad / Assessment - Assessment of the Health Board’s current position - Organisational risks - Evidence base to help inform decision making

Argymhelliad / Recommendation (N.B. Only one of the following directions should be identified for the Board):

Decision – i.e. reaching a conclusion after the consideration of options

Discussion – i.e. examine and consider the implications of a matter

For Information

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Amcanion: (rhaid cwblhau) Objectives: (must be completed)

Cyfeirnod Cofrestr Risg Risk Register Reference:

Safon(au) Gofal ac Iechyd: Health and Care Standard(s):

Choose an item. Choose an item. Choose an item. Choose an item.

Amcanion Strategol y BIP: UHB Strategic Objectives:

Choose an item. Choose an item. Choose an item. Choose an item.

Amcanion Llesiant BIP: UHB Well-being Objectives:

Hyperlink to HDdUHB Well-being Statement

Choose an item. Choose an item. Choose an item. Support people to live active, happy and healthy lives

Deddf Llesiant Cenedlaethau'r Dyfodol (Cymru) 2015

- Pum dull o weithio:

The Well-being of Future Generations (Wales) Act 2015

- 5 Ways of Working:

Please explain how each of the ‘5 Ways of Working’ will be demonstrated

Long term - the importance of balancing short-term needs with the need to safeguard the ability to also meet long-term needs

Prevention – the importance of preventing problems occurring or getting worse

Integration - the need to identify how the Health Board’s

well-being objectives may impact upon each of the well-

being goals, on its other objectives, or on the objectives of

other public bodies

Collaboration – acting in collaboration with anyone else (or

different parts of the organisation itself) which could help

the Health Board to meet its well-being objectives

Involvement - the importance of involving people with an interest in achieving the well-being goals, and ensuring that those people reflect the diversity of the area which the Health Board serve

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Nod Llesiant: Well-being Goals:

Hyperlink to The Essentials Guide to

Well-being Goals

Please explain where a contribution towards meeting the Well-being goals is demonstrated.

A Prosperous Wales - An innovative, productive and low carbon society which recognises the limits of the global environment and therefore uses resources efficiently and proportionately (including acting on climate change), and which develops a skilled and well-educated population in an economy which generates wealth and provides employment opportunities, allowing people to take advantage of the wealth generated through securing decent work.

A Resilient Wales - A nation which maintains and enhances a biodiverse natural environment with healthy functioning ecosystems that support social, economic and ecological resilience and the capacity to adapt to change (for example climate change).

A Healthier Wales - A nation which maintains and enhances a biodiverse natural environment with healthy functioning ecosystems that support social, economic and ecological resilience and the capacity to adapt to change (for example climate change).

A More Equal Wales - A society that enables people to fulfil their potential no matter what their background or circumstances (including their socio economic circumstances)

A Wales of Cohesive Communities - Attractive, viable, safe and well-connected communities.

A Wales of Vibrant Culture and Welsh Language - A society that promotes and protects culture, heritage and the Welsh language, and which encourages people to participate in the arts, sports and recreation.

A Globally Responsible Wales - A nation which, when doing anything to improve the economic, social, environmental and cultural well-being of Wales, takes account of whether doing such a thing may make a positive contribution to global well-being.

Gwybodaeth Ychwanegol: Further Information:

Ar sail tystiolaeth: Evidence Base:

Rhestr Termau: Glossary of Terms:

Partïon / Pwyllgorau â ymgynhorwyd ymlaen llaw y Cyfarfod Bwrdd Iechyd

Prifysgol: Parties / Committees consulted prior to

University Health Board:

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Effaith: (rhaid cwblhau) Impact: (must be completed)

Ariannol / Gwerth am Arian: Financial / Service:

e.g. financial impact or capital requirements: (if yes, please complete relevant section of the integrated impact assessment template available via the link below) http://howis.wales.nhs.uk/sitesplus/862/opendoc/453906

Ansawdd / Gofal Claf: Quality / Patient Care:

e.g. adverse quality and/or patient care outcomes/impacts: (if yes, please complete relevant section of the integrated impact assessment template available via the link below) http://howis.wales.nhs.uk/sitesplus/862/opendoc/453906

Gweithlu: Workforce:

e.g. adverse existing or future staffing impacts: (if yes, please complete relevant section of the integrated impact assessment template available via the link below) http://howis.wales.nhs.uk/sitesplus/862/opendoc/453906

Risg: Risk:

e.g. risks identified and plans to mitigate risks: (if yes, please complete relevant section of the integrated impact assessment template available via the link below) http://howis.wales.nhs.uk/sitesplus/862/opendoc/453906

Cyfreithiol: Legal:

e.g. legal impacts or likelihood of legal challenge: (if yes, please complete relevant section of the integrated impact assessment template available via the link below) http://howis.wales.nhs.uk/sitesplus/862/opendoc/453906

Enw Da: Reputational:

e.g. potential for political or media interest or public opposition: (if yes, please complete relevant section of the integrated impact assessment template available via the link below) http://howis.wales.nhs.uk/sitesplus/862/opendoc/453906

Gyfrinachedd: Privacy:

e.g. potential for data breaches: (if yes, please complete relevant section of the integrated impact assessment template available via the link below) http://howis.wales.nhs.uk/sitesplus/862/opendoc/453906

Cydraddoldeb: Equality:

e.g. potential negative/positive impacts identified in the Equality Impact Assessment (EqIA) documentation – follow link below

Has EqIA screening been undertaken? Yes/No (if yes, please supply copy, if no please state reason)

Has a full EqIA been undertaken? Yes/No (if yes please supply copy, if no please state reason)

http://howis.wales.nhs.uk/sitesplus/862/opendoc/453906

Hywel Dda SBAR Board Investment Report 02/06/16

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SBAR Template (Sample 2)

TITLE

AUTHOR

DATE

SITUATION

BACKGROUND

ASSESSMENT

RECOMMENDATION

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Resource Pack 19

Decision-Tracker (Sample)

The Tracker can assist in monitoring the progress of projects.

HDUHB Decision Tracker

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Resource Pack 20

Sample Cluster Lead Role 1. OVERALL AIM OF THE SERVICE To provide Primary Care clinical leadership within the specified locality/Cluster for the strategic development and planning of services, improvement in the quality and safety of primary care services, integrated working and chronic disease management. 2. SERVICE OBJECTIVES The aim of the service is to provide general practitioner leadership both at a corporate level and within the identified localities/Cluster s in developing a new service model for Hywel Dda University Health Board, where emphasis is on providing safe services of a high quality as close to a patient’s home as possible. This will be achieved through the development of primary care and community based services. 3. WHO WILL BE PROVIDED WITH THE SERVICE The Service Provider will work with the GP practices within their locality/Cluster as well as the secondary care providers, local authority, other primary care providers, the third sector and senior managers both within the county of the specified locality/Cluster and at a corporate level in Hywel Dda University Health Board. 4. LOCATION/S OF SERVICE The service will be provided in many settings where applicable 5. REQUIREMENTS TO DELIVER THE SERVICE

The Service Provider will be a general practitioner with enthusiasm, commitment to primary and community service improvement and required clinical and leadership skills.

Professionally and operationally accountable to the Associate Medical Director for Primary Care, Hywel Dda University Health Board.

To work collaboratively with the Primary Care Cluster Development Manager, providing clinical input, mentoring and support for the management/PT4L work programme of the locality/Cluster .

Act as Cluster Lead for the specific locality/Cluster to ensure that the Cluster develops and delivers a commissioning and improvement plan for the population of the specified locality/Cluster . This plan will be collectively agreed and be an integral part of the integrated networks/counties.

To provide clinical leadership for the specified locality/Cluster to ensure that Primary Care services are strong, sustainable and of high quality and where there are risks to support the implementation of mitigation actions. This will include communicating with and visiting individual practices with the support of the corporate Primary Care Team.

Act as Cluster lead in developing closer links and communication between the corporate University Health Board teams, secondary care providers, local authority and third sector with the GP Practices within the specified locality/Cluster . This communication link would act both ways with information, concerns and advice.

To actively promote positive peer review between primary care providers, including non-GMS providers, to share best practice and reduce inappropriate variation utilising available information

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and dashboards. This will require supporting a culture of openness within the specified locality/Cluster.

To act as GP link with specified work streams within the UHB. This will require information and views to be sought between the GP Lead network and with locality/Cluster stakeholders, it will also require some meetings to be attended and actions to be delivered. Intermittent reports will be required to the GP Leads meetings.

To represent the locality/Cluster at appropriate decision making forums and meetings in order to represent the benefits and abilities of primary care and to facilitate the shift of resources.

Ensure that the principles of governance, education, professional and service development underpin the work of the County GP Leads.

The Service Provider will be expected to attend leadership and quality improvement training arranged by the University Health Board and Welsh Government with other senior managers and clinicians.

SERVICE AVAILABILITY The Service Provider will be available to undertake this work for xxx sessions per month, for forty-six (46) weeks of the year. xxx sessions devoted to county, xxx sessions devoted to corporate. One session is equivalent to three and a half (3.5) hours. Role Redesign in the NHS in Wales

Example 2

BETSI CADWALADR UNIVERSITY LOCAL HEALTH BOARD

JOB DESCRIPTION JOB DETAILS Job Title: Cluster Lead

Grade:

Salary Scale : Consultant Grade

Hours: up to 2 sessions (7.5 hours) per week (Job share considered)

Department: Area Team East

Base: To be agreed dependent on area

ORGANISATIONAL ARRANGEMENTS: Accountable to: Area Medical Director Responsible to: Head of Primary Care & Commissioning

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KEY WORKING RELATIONSHIPS: Area Director LHB Clinical and other staff in the Cluster including Area Director of Clinical Services , Head of Community Services, Head of Pharmacy, Head of Therapies and all Cluster Support Staff GPs, Practice Managers and Nurses in the cluster Clinical and non-clinical staff outside the cluster, including clinical and non-clinical staff within BCUHB who are not area-based such as the Primary and Community Corporate Department, Primary Care Support Unit and Information Departments Local Public Health Wales Team Local Authority Staff leads in the cluster area and county Local Authority Elected Members Voluntary Sector Stakeholder Engagement Groups as appropriate

JOB PURPOSE: The postholder is responsible for leadership in the cluster, working closely with the Matron, social services senior managers, other local authority partners, third sector colleagues and stakeholders. The postholder is responsible for the leadership and development of the Cluster Team (previously known as Locality Leadership Team) including Local Authority lead staff and the third sector. The postholder will lead the planning, evaluation and delivery of local services according to population need and will promote the development of effective, efficient primary and community services for the cluster This will focus on seeking better integrated care to promote independence and reduce reliance on hospital care. The postholder will work closely with all the GP practices in the cluster, identifying areas of concern and discussing service change, as well as supporting the delivery of the relevant aspects of the GMS Contract, specifically the Locality Cluster Development Plan. The post holder will be either a clinician or other healthcare professional but in any event they will have knowledge of the local area and people working within it. They will lead the Cluster Team to identify and deliver opportunities for service change and improvement within the clusters and working across clusters as appropriate. DUTIES AND RESPONSIBILITIES:

LEADERSHIP Work with BCUHB senior clinicians, executive and senior managers, independent contractors, Local Authority, voluntary sector, Public Health Wales and other service providers in the cluster to develop effective care services which best meet the needs of the local population.

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Establish effective relationships with, and gain the support of GPs and all practice staff within the cluster to develop the service model including the delivery of service changes and support the delivery of the relevant elements of the GMS contract. This will focus on the on going implementation and monitoring of the Cluster Plan in line with population need and strategic plans, informing the Health Board Operational Plan. Promote a culture based on safe, effective clinical practice, encouraging initiative, high standards of performance and quality of care which demonstrates sound clinical governance. Support the development of effective clinical partnerships in the cluster and across boundaries. Drive forward a culture of change, innovation and modernisation to underpin the development of the cluster and facilitate improvement in clinical services. Support the development of local policies and procedures with adherence with organisational policies. Represent the Cluster at Area meetings, public meetings, LA meetings, relevant BCUHB meetings. Provide papers, presentations and locality feedback on all relevant areas, recognising that some of these may be contentious and require strong change management skills. Represent the Cluster within the LHB and other organisations’ meetings as required, contributing to the strategic development of health services and other priorities in the locality. Develop effective communication methods with practitioners and staff within the cluster regarding service aims and progress in achieving change. Promote effective engagement with secondary care and community services to support the development and delivery of services in the cluster eg Mental Health, Children’s Services, Therapies SERVICE DELIVERY AND PERFORMANCE Lead the Cluster Team and liaise with corporate and area senior managers to ensure sound Cluster plans are agreed and delivered, supported by robust performance managements arrangements. Support the Area Team in addressing specific priorities and issues in relation to individual practices, local services and the Cluster as a whole. Chair Cluster meetings and monitor progress of Cluster plans in partnership with cluster support staff. Support the Cluster Team members in the management of community services within the locality. Ensure strategic area plans support the delivery of locality/cluster priorities. Share learning and developments with counterparts across BCU to enable spread of good practice. Seek opportunities to develop community based care in line with the Board’s strategic direction for Primary and Community health services. Lead the cluster in developing these opportunities and delivering the necessary service changes.

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PATIENT CARE PATHWAYS Lead the evaluation of patient pathways and service provision within the cluster, identifying deficiencies and working with local staff to implement service improvement. Develop proposals for the reconfiguration of health and social care services and the development of innovative community based services in the cluster, using agreed pathways of care between primary and secondary care to reduce dependence on acute hospitals. Promote the development of out of hospital services challenging traditional service models and supporting service redesign. RESOURCE MANAGEMENT Lead the drive towards the reduction of harm, waste and variation in clinical service delivery, with a focus on prudent healthcare Working with the other Cluster Leads review and demonstrate the effective use of resources within the cluster to deliver ‘Value for Money’, maximum benefit to patients and ensure services are safe and provided within the resources available. Support the development of cluster budgets and lead the management of these resources. Influence primary care clinicians in their use of resources e.g. prescribing and referrals, to promote high quality, evidence based, cost effective service delivery. Work with colleagues to develop cost effective service models which maximise the potential of community based services and deliver value for money.

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Resource Pack 21

Sample Cluster Practice Manager Role 1. OVERALL AIM OF THE SERVICE The Cluster Practice Manager Lead will work in collaboration with the Cluster Development Manager and GP Lead to support the business case development, implementation, administrative work, communication and engagement of the Locality. 2. SERVICE OBJECTIVES The aim of the service is to provide Practice Manager leadership both at a corporate level and within the identified localities in developing a new service model for Hywel Dda University Health Board, where emphasis is on providing safe services of a high quality as close to a patient’s home as possible. This will be achieved through the development of primary care and community based services. 3. WHO WILL BE PROVIDED WITH THE SERVICE The Service Provider will work with the Cluster Development Manager, GP Lead and GP practices within their locality. 4. LOCATION/S OF SERVICE The service will be provided in many settings where applicable 5. REQUIREMENTS TO DELIVER THE SERVICE Main Duties and Responsibilities

Liaise with Practice, other stakeholders, GP Lead and Cluster Development Manager to organise Cluster meetings.

Liaise with the Cluster Development Manager and GP Lead to structure agenda’s and supportive information for the Cluster meeting in order to achieve the key goals.

Attend all Cluster meetings.

Work with the GP Lead and Cluster Development Manager to profile information for the practices and the Cluster to support with discussion and decision making.

To actively participate in Projects agreed within the Locality, these could include data validation, service redesign and patient profile. This may include engaging with Cluster Practices and other stakeholder professionals and organisations in their completion of this work and compiling the overall results, business case development or other stakeholder meetings.

To actively engage and encourage involvement of, with and consultation of patients in Cluster ideas and project work.

Service Redesign / Improvement

To support and work collaboratively with the GP Lead and Cluster Development Manager in these projects including the development of plans to utilise Cluster funding

Education 6. To take a lead role, in liaison with the GP Lead and Cluster Development Manager to ensure

that Cluster education needs are identified, collated and auctioned. 7. SERVICE AVAILABILITY The Service Provider will be available to undertake this work for up to 15 hours per calendar month.

Practice manager, Meddygfa Pen-y-Bont Surgery – The Support Network

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Resource Pack 22

Role of Health Board Executive Lead for Clusters

59

Resource Pack 23

Role of Cluster Support Manager

BETSI CADWALADR UNIVERSITY LOCAL HEALTH BOARD

JOB DESCRIPTION

SENIOR CLUSTER CO-ORDINATOR

JOB DETAILS Job Title: Senior Cluster Co-ordinator Grade: Band 7 Hours of Work: 37 ½ Hours Department Area Team – East/Central/West Base:

ORGANISATIONAL ARRANGEMENTS Accountable to: Assistant Area Director for Primary Care & Commissioning (East/Central/West) Professionally accountable and Reports to: as above Key Relationships: All clusters in the area Cluster Leads Cluster Co-ordinators Others dependent upon area structures

JOB PURPOSE The post holder will work with Cluster Leads and Cluster members to develop the roles and functions of Clusters in line with aspirations set within the Health Board’s Primary Care Strategy The post holder will be responsible for providing support and leadership to the Clusters and the Area Management Team to ensure that primary care services are developed and deployed effectively as a critical part of a strong primary and community model of service delivery. The post holder will manage the Cluster Co-ordinators.

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DUTIES AND RESPONSIBILITIES

Support and contribute to the development and implementation of Cluster and/or Area based services to improve community health and well being in line with local, regional and national strategies.

Ensure that a range of programmes and projects relating to Cluster developments are managed, monitored and reported

Negotiate, influence and manage one to one and group meetings with a wide range of individuals across all sectors to effectively engage and support the delivery of Cluster based developments

Communicate and advocate for priority areas for development/improvement as defined within Cluster Plans to partners, including primary and secondary care, social services and the voluntary sector.

With partners, develop, sustain and evaluate mechanisms to support complex collaborative working

Provide information to support and influence strategy development

Support the development of innovative community based services in the Area, using agreed pathways of care between primary, community and secondary care to reduce dependence on acute hospitals.

Support the Area Management Team in the development of strategies to meet the locality needs for health and well-being services

Responsible for the development and implementation of evaluation frameworks aligned to agreed policies

Analyse data and information, including relevant service profiles, key outcome indicators, financial and risk profiles, to make recommendations on service developments to the Area Management Team and senior managers across partner organisatios.

Decision making based on analysis, interpretation and comparison of highly complex, sensitive and potentially contentious information.

Undertake the analysis of both clinical and service issues, and make recommendations on response options to the Area Mangement Team or other decision makers

Work collaboratively with Public Health Wales practitioners to analyse and interpret relevant/complex data and information about community health and wellbeing within the Area and at Cluster level.

Lead the collation of information relating to and evaluation of current pathways and service provision within the locality, identifying gaps and working with appropriate health, social care managers and voluntary sector representatives to develop and design service improvement strategies

Communications and Relationship Development

Establish effective relationships with Cluster Leads and Members along with other key senior health and social care professionals and voluntary, independent and third sector service providers responsible for the delivery of services within theArea..

Establish effective relationships with key individuals across the region to ensure that Area developments are aligned across geographical / administrative boundaries, and that information on needs and services is shared

Lead the establishment of comprehensive processes for securing the engagement of service users / user representatives in the design and delivery of the services within and across Cluster boundaries.

. Provides and receives highly complex, sensitive and potentially contentious patient and or commercial information

Establish effective communication methods to report progress in achieving change and improvement to Boards, NHS and Local Authority management teams, staff and service user groups, and other community stakeholder groups as appropriate

Highly specialist knowledge base that facilitates communication at senior management and executive level.

Resources

Analyse relevant data and information to inform the future allocation of Cluster funding and other primary care budgets

Contribute to the drawing up of the annual budget plans for the Area based Clusters

Manage and monitor allocated budgets

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Has the capacity and capability for working practices that require prolonged mental effort in terms of highly complex analysis and interpretation

Leadership Promote a culture which encourages initiative, high standards of performance and quality of care and supports clinical governance through effective management by:

undertaking regular PDR/PDP using KSF Outlines

undertaking analysis of own development needs

dealing with day to day management of the cluster co-ordinators

undertaking presentations/training to staff both internally and externally Information Management

Receive, analyse, and process highly complex information from multiple sources

Research, analyse and report additional and supporting information needed by the Cluster and Area Management Team to make decisions about the local configuration of health and social care services

Use and develop methods and systems to communicate, record and report on Cluster developments

To explore evidence based best practice within Wales, the UK and abroad

Analyse data and complex information and break down problems into their component parts, identify solutions and make recommendations

Develop and produce reports, spreadsheets and create and maintain databases on a regular basis

Analyse policy documents in order to summarise, distil and re-present these in a format for a wide range of audiences particularly at facilitated meetings where people may be unknown

Service Improvement

Assess the evidence and impact of the health and wellbeing interventions, programmes and services delivered within primary care

Contribute to ongoing research on the needs of the population for the provision of Primary and community services.

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Resource Pack 24

Role of Project Support Officer

Description JOB TITLE: Cluster Coordinator Band: Band 5 Accountable to: Senior Cluster Coordinator Responsible for: n/a Key Relationships: Assistant Area Director Primary Care & Commissioning Commissioning Manager Area Medical Director Central Area Senior Leadership Team

Primary Care Senior Managers Area Management Teams Corporate Planning Department Local Authorities officers Third Sector organisations Independent contractors Staff Cluster Clinical Leads & Cluster Teams

Finance Officers & Costing Accountants Information Officers Welsh Health Informatics Service Staff PHW Job Purpose / Summary The post holder will be part of the Primary Care Area Team, responsible for the development and implementation of the primary and community services strategy across the organisation including the development of the cluster model of service delivery. There are 14 clusters across North Wales, each has a cluster team responsible for the planning and improvement of local primary care and community services within their locality. The post holder will support cluster leads in the collation and production of cluster plans and support the overall development and administration of clusters. The postholder will work closely with the Department team, Area Team colleagues and members of each cluster to generate mapped information (e.g. demographics, performance indicators, and other public sector information) to support strategic planning and service re-design, at a locality, county, Area and North Wales level. Working with the Senior Cluster Coordinator this post will support the roll out and development of the cluster networks.

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Specific Responsibilities Primary Care and Community Services Development Support the Primary Care Area Team in the implementation programme for the Primary and Community Services Strategy, Area Plans and Cluster Plans, leading on specific projects or areas of work. Support the development of the cluster network across the Area and working with other North Wales cluster coordinators, working across the organisation/Area and externally with independent contractors staff and partner organisations to provide information at a locality and practice level. Work closely with the Cluster Teams and Cluster Clinical Leads in agreeing information requirements and the provision of information to support cluster plans/priorities. Working across Area Teams, and with Planning, Secondary Care Teams, provide information to support the development of business cases for strategic change in primary care/community based services as required. Support the development of cluster plans and coordinate the implementation of actions within the plans Data Analysis Services

Working closely with the Department team, information & finance colleagues, support the further development of information to support the clusters.

Develop detailed knowledge of specific areas of service re-design and development in order to be able to support the Primary Care Area team to analyse information and model future scenarios Develop, utilise & maintain reporting systems to consolidate department and cluster information requirements

Develop & utilise user-friendly reporting systems to assimilate and report on information from a wide variety of sources in an appropriate format to support effective monitoring, planning and decision making within the primary care directorate. E.g. Systems to monitor the cluster action plan delivery

Test new software as required

Data Reporting and Communication

Develop and prepare written reports in line with areas of key responsibility

Ensure reports are compiled, validated and issued within the agreed timeframes, with information presented in an appropriate and user-friendly way.

Prepare information for presentation to the Primary Care Area Team, Area Senior Managers, Clusters and clinicians, with a view to supporting the operational efficiency, planning, service development and change agendas.

Prepare information for national conferences as required and meetings using a variety of presentation skills and media including charts, graphs and maps.

Communicate directly with clusters to present information and data. Respond effectively to challenge and questioning. Attend and support cluster meetings on behalf of the Area. Support cluster meetings as required eg. Specific project support, developing action plans

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Develop effective working relationships with primary care staff and partners, such as Local Authorities and the Voluntary Sector, to coordinate methodologies and interpret information, promoting a collective approach to cluster information mapping.

Forge working relationships with clusters, responding to requests and queries, to enable them to make best use of the information provided and deliver priorities and actions at a cluster level.

Lead on specific actions as identified in cluster plans.

Performance Management Working with the Primary Care Area Team monitor agreed outcome measures, action plans and projects for clusters, as part of a performance management framework and prepare reports as required. Working with the Primary Care Area Team develop, coordinate and review information and progress to provide regular updates which track progress against cluster plans.

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Resource Pack 25

Role of Locality Manager

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Resource Pack 26

Business Case Template – including Options Appraisal

Title

Purpose of this document

This document summarises the benefits to be delivered by the project and demonstrates that these benefits can be realised through the project as proposed. The business case will compare expected patient outcomes and financial cost of the current service with that of the revised service, using firm data where available and making clear assumptions where data is not available.

Senior Responsible Officer:

Service Development Lead:

Clinical Lead: Document Control

Versions

Date Version Section(s) Affected Description of Change

Approvals

Date Version Name Title Organisation

Strategic Fit

Project aligned to (Evidence of National & Local Fit):

IMTP 7 Pillars Foundations 4 Change Other : [specify]

Existing Arrangements

Please specify the current service in place

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Strategic Risks

Outline the risks of continuing with this service, consider:

Patient Experience

Quality & Safety

Service Sustainability

Service Demand

Finance

Equality Impact Assessment

Please refer to HB guidance

Patient & Public Engagement

Include feedback on existing service, complaints, ombudsman, AM/MP letters etc

Options Appraisal

Option One

Proposal

Provide an outline of the option including:

How will the new service be delivered

By whom and what clinical / service expertise they have

When will the service operate

What is the volume of delivery and how does this match demand Please include as appendices any technical documentation / evidence / service specification / flow charts.

Risks

Outline the risks of continuing with this service, consider:

Patient Experience

Quality & Safety

Service Sustainability

Finance

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Benefits

Clinical Benefits:

Patient Benefits:

Staff Benefits:

Financial Benefits:

Capital Costs

Outline any capital costs including all IT hardware, estates, or equipment over £5k

Non-Recurrent Costs

Outline all initial start up costs to commence the service

Recurrent Costs

Outline all on-going running costs including any changes over time anticipated

Year 1 Year 2 Year 3 Year 4 Year 5

Recurrent Costs

Savings

If you anticipate that the service will make savings elsewere these need to be identified and quantified. An explanation will be needed for any evidence to support this.

Year 1 Year 2 Year 3 Year 4 Year 5

Savings

Transfer in Funding

Please quantify the exact funding required for the delivery of the service.

Year 1 Year 2 Year 3 Year 4 Year 5

Capital costs

Non-recurrent costs

Recurrent Costs

Savings

Balance

Opportunity for Innovation

Identify anything that is particularly innovative or new about the service.

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Option Two

Proposal

Provide an outline of the option including:

How will the new service be delivered

By whom and what clinical / service expertise they have

When will the service operate

What is the volume of delivery and how does this match demand Please include as appendices any technical documentation / evidence / service specification / flow charts.

Risks

Outline the risks of continuing with this service, consider:

Patient Experience

Quality & Safety

Service Sustainability

Finance

Benefit

Clinical Benefits

Patient Benefits

Staff Benefits

Financial Benefits

Capital Costs

Outline any capital costs including all IT hardware, estates, or equipment over £5k

Non-Recurrent Costs

Outline all initial start up costs to commence the service

Recurrent Costs

Outline all on-going running costs including any changes over time anticipated

Year 1 Year 2 Year 3 Year 4 Year 5

Recurrent Costs

Savings

If you anticipate that the service will make savings elsewere these need to be identified and quantified. An explanation will be needed for any evidence to support this.

Year 1 Year 2 Year 3 Year 4 Year 5

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Savings

Transfer in Funding

Please quantify the exact funding required for the delivery of the service.

Year 1 Year 2 Year 3 Year 4 Year 5

Capital costs

Non-recurrent costs

Recurrent Costs

Savings

Balance

Opportunity for Innovation

Identify anything that is particularly innovative or new about the service.

Please add in as many options as appropriate following the same format. There should be at least 2 options – Preferred Option & Do Nothing

Preferred Option

Please state which of the options outlined above is your recommendation and why.

The following is based upon the preferred option:

Procurement / Commissioning

Procurement Strategy

Please specify how you will procure / commission the service and what procurement advice you have received

Risk Transfer

Please identify any risks inherent in the transfer of the service and how you will mitigate these.

Contract Length

Please state if this is an on-going service change or a pilot / project

Workforce & Personal Development (inc. TUPE & Pension)

Please identify any HR issues – take HR advice on this prior to submission.

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Project Management

Project Manager Time

Identify how the project will be managed during the development, implementation and delivery phase. Also identify any project managemt support needed for evaluation and reporting.

Completion Schedule

Outline the timeline for implementation of the project.

Contingency Plan

Please identify any contingencies identified to mitigate risks outlined in your preferred option appraisal.

Evaluation of Service

How will the service be evaluated and which group will this be reported to.

Evaluation Benefit Performance Indicator Method of Measurement

Frequency of Measurement

Clinical

Patient experience

Finance

Other [specify]

Summary of Project Objectives

Achievement of expected benefits

Refer to the benefits outlines in the proposal or business case approved submission

Financial Costs & Benefits

Cost of the scheme Benefits of the scheme

Unexpected benefits

Unexpected problems

Patient Engagement

Recommendations for Action

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Resource Pack 27

For each component of the logic model, the following could be considered: Component Considerations Potential Measures Input What resources are needed or used to develop/ deliver the

project? (staff time, partners, equipment, financial, physical) Cost of project/ intervention

Output (what) Activities e.g. meetings, training, services delivered during the intervention

Methods used, demographic characteristics of population reached, participant satisfaction

Output (who) Who engaged with the project/intervention (Participants) Number and reach (people, staff, organisations, decision-makers, participants)

Outcomes (short term)

What difference did the project make in the short term Benefits to participants/ those delivering intervention, knowledge, skills, confidence, motivation, aspirations

Outcomes (medium term)

What difference did the project make in the medium term Changes to practice and policies

Outcomes (long term impact)

What is the potential long term impact of the project

Health, social, economic and organisational impacts

When determining evaluation measures, consideration should also be given to any external influential factors and assumptions held that potentially impact on the project:

Assumptions Any assumptions held about the impact or effect of the intervention

External Factors / influences

Workforce capacity, stakeholders buy in, participant involvement, etc.

Logic models can be used as a planning tool to provide narrative about the purpose of a project/programme or intervention. It sets out the components and sequences of activities needed to achieve the project’s goal/aim. It helps identify evaluation priorities and questions to be answered by the evaluation.

Logic Models in Evaluation

Acknowledgment: This resource utilises a template developed by Rebecca Stewart based on a framework developed by PHW Health Improvement Division and Public Health England

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LOGIC MODEL

Project Name:

Project overview (including aim):

Local context:

Inputs What we invest

Outputs Outcomes (short term)

Outcomes (medium term)

Outcomes (long term) Intervention

What we do Participants

Who we will reach

Assumptions External Factors/ Influences

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EVALUATION PLAN

What do we want to know? (Evaluation Question)

How will we know it? (Indicator)

How to collect information about the indicator? (Data source/ method)

When and where will info be collected? (Timeframe)

Who will do this? (Responsibility)

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Evaluation Types When to use What it shows Why it is useful Formative evaluation Evaluability Assessment Needs Assessment

During the development of a new programme/ project

When an existing programme is being modified or is being used in a new setting or with a new population

Whether the proposed programme elements are likely to be needed, understood and accepted by the population you want to reach

The extent to which an evaluation is possible, based on the goals and objectives

It allows for modifications to be made to the plan before full implementation begins

Maximises the likelihood that the programme will succeed

Process Evaluation Programme Monitoring

As soon as programme implementation begins

During operation of an existing programme

How well the programme is working.

The extent to which the programme is being implemented as designed

Whether the programme is accessible and acceptable to its target population

Provides an early warning for any problem that may occur

Allows programmes to monitor how well their programme plans and activities are working

Outcome Evaluation Objectives-based evaluation

After the programme has made contact with at least one person or group in the target population

The degree to which the programme is having an effect on the target population’s behaviour

Tells whether the programme is being effective in meeting its objectives

Economic Evaluation: Cost Analysis, Cost-effectiveness Evaluation, Cost- Benefit Analysis; Cost- Utility Analysis

1. At the beginning of a programme 2. During the operation of an

existing programme

3. What resources are being used in a programme and their costs (direct and indirect) compared to outcomes

4. Provides programme managers and funders a way to assess cost relative to effects “How much bang for your buck”

Impact Evaluation 5. During the operation of an existing programme at appropriate intervals

6. At the end of a programme

7. The degree to which the programme meets its ultimate goal

8. Provides evidence for use in policy and funding decisions

TYPES AND USES OF EVALUATION

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Resource Pack 28

Project Proposal Document Title

Purpose of this document

To provide sufficient evidence on proposed projects to either utilise existing Primary Care funding or to develop a Business Case for resource shift. The information provided will enable assessment of strategic alignment, value for money, quality of service and benefits to patients including any relevant quality standards including.

Senior Responsible Officer : Service Development Lead : Clinical Lead :

1. Reason / Identified Need for the Service Redesign / Development

Why service redesign proposed and whether any other similar service exists accessible to Practice / patients

If another service why is something different preferable?

Benchmarking evidence to suggest need including any public health evidence to support the proposal.

Number of patients that the service will affect.

2. Summary of the Service Redesign/Development

1. Main features of the service proposed. 2. How different from other similar existing services.

3. Benefits, Outcomes & Evaluation of the Project

Benefit Performance indicator Method of measurement

Frequency of measurement

Clinical

Patient experience

Financial

Other e.g. staff, technological, knowledge etc

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4. Strategic Compliance a. HB Mission Statement : Specify …………………………………………………………………… b. IMTP : Specify ……………………………………………………………………............................. c. Primary Care 7 Pillars : Specify ……………………………………………………………………... d. Foundations 4 Change : Specify ……………………………………………………………………..

5. Information a. Baseline activity of each Performance Indicator. b. Anticipated future activity. c. Identified shifts in activity between providers.

6. Finance & Funding a. Costs associated with new service/activity. b. Details of quotes for equipment / other providers and reasons for preferred source. c. Anticipated savings to be released through redirected activity or other route. d. Breakdown of funding required for proposal :

7. Stakeholder Engagement

Approach to patient / public engagement

Self care initiatives within the proposal

Example of questionnaire questions where applicable.

8. Initial assessment of risk a. Risks associated with doing the project b. Risks associated with not doing the project c. A brief view of mitigation of these risks. d. Exit strategy

Signature of Lead:

Date:

HB Action:

Stakeholders consulted with & dates

Date discussed by PCSC

Outcome of PCSC review

Date of follow up / evaluation report

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Resource Pack 29

Primary Care Development Project Template

Stats & Facts Add here bullet point facts, data, achievements

Headline / Purpose Add here a catchy title that clearly articulates the service development undertaken- what locality Add the name/s and contact details for those who know more and can provide more information

Image A Photo, a graph, something which shows what you are doing / achieving

Pain Describe briefly the problem or challenges – why was this a priority?

Vision Describe here what it is you set out to do, what did you want to achieve

Solution What did you learn, what did you achieve, what have you got that you could share with others e.g. job descriptions, policy, flow chart, read code template, single action tender etc Embed key documents e.g. JDs

Final Catchphrase What is the one take away achievement…a quote is always good from a service user or clinician

Lessons Learnt What particular barriers did you face and how did you overcome them?

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Resource Pack 30

Goal Directed Plan Template

Work stream

Work stream Work stream Work stream

Milestone

Milestone Milestone Milestone

Milestone

Milestone Milestone Milestone

Milestone

Milestone Milestone Milestone

Milestone

Milestone Milestone Milestone

Goal

Goal Goal Goal

Overall Goal / Charter Statement

Maximum 35 words

Step 1 Identify Work streams &

Allocate Responsibilities The project team decides on an appropriate set of work streams for the project. There is no fixed rule as to which work streams should be selected, but if a particular, aspect requires a certain emphasis it should be given a path of its own.

Step 2 Define Goals (SMART) The owner and project team members identify the goals for each work stream.

Step 3 Identify Milestones Identify milestones for each work stream. Milestones, unlike activities or tasks can be identified far in advance.

Step 4 Establish Dependencies Dependencies between milestones are established and broad target dates are set.

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Resource Pack 31

Project Action Plan Template

Date of meeting agreed at

Task Number

Task Description Duration to Complete

Completion Date

Responsibilities Resources Required

Responsible to complete

Accountable / Support

1

2

3

4

5

6

7

8

9

10

11

12

13

14

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Resource Pack 32

Highlight Report Templates (Sample)

A template can be used for monthly updates can to ensure progress, achievements and risks are reported and, if necessary, escalated.

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Resource Pack 33

Post Project Review

Title Senior Responsible Officer : Service Development Lead : Clinical Lead : Document Control Versions

Date Version Section(s) Affected Description of Change

Approvals

Date Version Name Title Organisation

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Resource Pack 34

Resource Shift Framework

WHC (2018) Rhif / Number 025

Title: Improving Value through Allocative & Technical Efficiency: A Financial Framework to Support Secondary Acute Services Shift to Community/Primary

Service Delivery

This framework has been developed by health board directors of finance working together with directors of primary and community care.

A Healthier Wales: Our Plan for Health and Social Care (2018) articulates our vision for health and social care in Wales. We want to see a 'whole system approach to health and social care', which is focussed on health and wellbeing, and on preventing illness. Specifically, the plan references services which are seamless, delivered as close to home as possible. It has been well recognised for some time that a shift of services out of hospital to the community is required, however this has proved challenging to achieve.

This framework seeks to provide a tool to support this shift. Whilst the framework is predominantly directed at the shift of services from secondary to primary and community care, the principles can be used in the broadest sense, considering alternative providers (such as local authorities and the third sector). The expectation is that this tool will be used to support the implementation of future service change plans involving shifting services from acute hospital setting into the community and primary care setting.

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Resource Pack 40 Social Enterprise Cluster Toolkit

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Resource Pack 35

Primary Care Project Initiation & Business Case Development Process

Approval & Sustainable

Implementation

Approval for Development

Assessment of Scope & Benefit

Project Identification &

Pilot

Business Case Development

Contractor Innovation

Initially identified by contractor and

piloted through core / enhanced funding

Cluster Priority Initially identified

within Cluster and pilot supported with

local funding

HB Priority Initially identified by HB team and piloted

through non-recurrent funding / budget / slippage

Benefit Identification Early evaluation / assessment indicates that :

There could be a benefit to offering service across Health Board There could be a spend to save benefit There could be a significant improvement in experience, safety and / or

outcomes There could be a care closer to home shift of service

SBAR to Primary Care Sub-Committee Feedback to include :

Support for development of business case or not Rationale or further information required where not supported Stakeholders to be consulted during business case development e.g.

Executive Team, contractor group, patients etc Identification of Project Sponsor & Team

Business Case Development Outcome of project to be clearly articulated Service change to be described Success criteria and baseline measures to be identified Cost of revenue and capital required Volume of service and impact across the Health Board to be identified

and costed Clinical governance & safety issues to be identified Patient experience indicators & Equality Impact Assessment to be

completed Impact of not delivering the service & exit strategy if BC not supported Strategic fit to be articulated – strategic priorities

Business Planning, Performance and Assurance Committee To consider Business Case and Equality Impact Assessment:

Is there support for the service Can funding be identified to sustainably deliver the service change What are the implications of not supporting the service / costs

BC Approved & Funded Implement, monitor, review &

feedback to PCSC

BC Not Approved/Funded Implement exit strategy

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Resource Pack 41 A Frequently Asked Questions guide to procurement for primary care cluster leads

This is public money I want to invest so are there any rules I need to follow? Yes.

Managing Welsh public money' http://gov.wales/funding/managing-welsh-public-money/?lang=en sets out the framework and principles which must be applied by the Welsh Government, and its sponsored bodies which includes the NHS.

To ensure the appropriate use of public funding and value for money in accordance with Managing Welsh Public Money, the Welsh Government issues Standing Financial Instructions to local health boards and NHS Trusts in Wales. The NHS Standing Financial Instructions can be found at: http://www.wales.nhs.uk/sitesplus/862/pape/74298 What are the main procurement thresholds? If the likely cost is:

Less than £5,000 you can procure on the basis of one written quote from one supplier;

Between £5,000 and £24999, you must seek at least written quotes from at least 3 suppliers;

Between £25,000 and £106,047 contracts are subject to a formal tendering process;

Services contracts with a minimum value of £106,047 are subject to European Union Procurement Regulations.

Procurement Thresholds

The following table summarises the minimum thresholds for quotes and competitive tendering arrangements. The

total value of the contract over its entire period is the qualifying sum that should be applied (except in specific

circumstances relating to aggregation and contracts of an indeterminate duration) as set out in EU Directives and

UK Regulations.

Contract value (excl. VAT)

Minimum competition'

<£5,000 At discretion of Directors of Finance

£5,000 - £25,000 3 written quotations

£25,000 — OJEU threshold 4 tenders

Above OJEU threshold 5 tenders

1 subject to the existence of suitable suppliers

This is the extract from the Standing Financial Instructions, however, please note that the values and thresholds contained within this document are currently being reviewed and may well alter. The value of the OJEU threshold is normally amended every 2 years. Communication of changes will be advised if they arise.

Will Brexit change anything?

Under the Great Repeal Bill provisions the UK will have the opportunity to consider which European Union Legislation in relation to Procurement to retain in UK legislation, and where amendment is required. It is too early to assess presently what changes will be made to procurement as a consequence.

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What am I responsible for and what will the health board do to support me?

A guide on the roles and responsibilities of clusters, health board primary care teams and procurement expertise from Shared Services partnership is at Annex A.

Will procurement requirements slow down the pace at which I can implement my cluster plan?

Procurement processes required for Health Boards to be compliant with their SFI's should not cause unreasonable delay where the process is well planned and implemented.

What is key to fast procurement?

The following will avoid unnecessary delays:

Clear identification of what is needed, concise and clear scoping of goods or service sought.

This will require wider coordination to ensure that there are not multiple/duplicated requirements as

this will not be supported.

Clear communication of key deadlines and interdependencies

Clear leads in place for the procuring cluster, primary care and NHS Procurement to

ensure a chain of communication

shared understanding of roles and responsibilities

Does the procurement process have to wait until all clusters in my health board have finalised

their plans? Not necessarily.

Procurement professionals are required to bring together similar procurement requirements wherever

possible to maximise the benefits of framework procurement and economies of scale. Co-ordination of

procurement requirements if multiple clusters require the same goods or services achieves better value for

money and avoids duplication of effort.

However if such and approach could cause unreasonable delay for an individual cluster, procurement leads

should work with health board cluster support and cluster leads to reach an appropriate solution.

Under what circumstances would procurement not have to follow the Standing Financial Instructions?

Where a Health Board is leading the procurement, there are no circumstances in which they cannot follows

SFIs, Health Boards must follow SF's in all procurement.

If an individual primary care contractor is undertaking procurement on behalf of the cluster, although they are not

bound by the LHB SFIs, as recipients of public money, procurement must be conducted in line with Managing

Welsh Public Money. If any procurement conditions have been placed on the funding for the procurement by the

health board — which may follow their SFIs, these must also be followed.

If I do not spend all of my cluster's funding in any given financial year, can I carry it forward to the

following year?

If the health board is responsible for accounting for the goods and services you invest your share of the £10

million, the cluster's spending plan must be planned and implemented to incur spend in the financial year. To

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avoid underspending and losing any of this funding you should finalise the cluster's spending plan well in

advance of the start of the financial year.

Where there is an unforeseen underspend against the cluster's spending plan, the cluster should identify an

alternative use on one off activity which offers value for money. Where this is not an option, you can ask the health

board to consider re-providing the underspend for one off activity the following financial year. The health board will

consider this in the context of its broader financial position.

In exceptional circumstances it may be appropriate for cluster funding to be transferred by way of a grant to a

primary care contractor, rather than held by a health board. If local circumstances indicate this may be

appropriate, advice should be sought from local health board finance teams, in conjunction with the cluster

lead and governance colleagues as appropriate.

Annex A

Primary care cluster leads should:

Plan their activity.

Timetable their stages.

Identify and scope procurement needs.

Build appropriate procurement lead time into their plans.

Engage with their Procurement Leads at the earliest opportunity in order to obtain appropriate advice

before progressing with any project or procurement.

Seek wherever possible to enshrine the Welsh Government principle of "Once for Wales" in

considering any procurement activity.

Health board directors of primary, community and mental health should:

Oversee planning and timetabling.

Engage with procurement lead at the earliest opportunity once a requirement is established.

Act as a link between procurement and the clusters to advise how procurement will be

taken forward and the rationale for this.

Act as a link to respond to issues and concerns between the clusters and procurement leads.

Shared Services Partnership procurement service leads in health boards should:

Be clear on what information is required to scope procurement activity — (this will feature as output

from the IMTP process). Also to review the requirements and identify any associated costs to support.

Be clear on what procurement rules apply.

Be clear on expectations for how long a procurement approach will take and agree key target dates

with primary care directors.

Respond to queries from clusters / primary care directors.

Ensure procurement is undertaken to achieve value for money and complies with NHS Standing

Financial Instructions and procurement regulations.

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Resource Pack 36 Operational and Professional Management Protocol

for Staff Employed by the Local Health Board working in GP Practices Introduction Clusters may decide to employ professionals within the cluster team to provide patient facing support in practices. Staff can be employed by the UHB, with the Cluster managing their objective setting and work plans.

Aim of the Protocol

To aid the delivery of effective, efficient and person centred services.

To enhance team working

To ensure clarity exists around the parameters of the Operational Manager and Professional Manager roles.

To ensure there are clear reporting arrangements and lines of accountability.

To prevent disciplines becoming distanced and dislocated from professional support networks.

To define the management organisational structure.

To ensure clarity of communication processes

Who is affected This will affect all UHB employed staff who work within the Clusters.

Status of the Protocol Responsibility for operational and overall performance management of the staff sits with the Community Director/designated GP lead in terms of the interface with practices. The relevant professional leads retain responsibility for key professional issues as detailed below. The Cluster Manager is responsible for the budgetary/general staff management issues surrounding the posts.

Checklist of Key Responsibilities To work in multi agency, multi professional team all partners need to have an involvement in the decision making process to deliver safe clinical services with professionally skilled staff. However, to ensure clarity of accountability, decision-making and communication, for each identified area there will be a clearly identified lead as indicated in the table below. Changes to lead roles can only be agreed through discussion between relevant professional heads and service managers.

LEAD MANAGER (Lead person indicated in bold)

Cluster

Manager/ Deputy

Professional

Team Manager

Community

Director/

Designated PM

lead

Enrolment – staff member to attend LHB on day one to complete enrolment and obtain photo ID

LM

Corporate Induction LM

Operational – Individual day-to-day workload management, location, accommodation, nadex activiation and performance,

PM

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Operational – Individual day-to-day workload management and performance relating to professional role in the team

PTM

Operational – Cluster /practice policy, procedure, guidelines and protocols etc

CD

PM

Professional – Policies, procedures, guidelines and professional related protocols etc

PTM

Professional Development / Team Building and support (in conjunction with other Cluster pharmacists) Professional supervision (including engagement of staff in relevant professional specific meetings)

PTM

Clinical Supervision

CD

Appraisal/PADR (jointly managed) Assessing continuing professional development needs, PADR discussion – jointly between CD/lead GP and Professional lead Ensuring completion of PADR documentation Recording of completed PADRs

LM

PTM

PTM

CD

Identification of appropriate Study Leave opportunities linked to professional development disciplinary (linked to PADR process)

PTM

CD

PM

Final authorisation of costs of proposed study leave

LM

Identification of conduct/capability/performance issues

CD

PM

Initial management of conduct/capability/performance issues (with subsequent discussion with PM) LM or PTM depending upon issue

LM

PTM

Oversight of the management of conduct/ capability/ performance issues

LM

Mandatory Training

LM

Lone Worker Escalation and Device

LM

PM

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Usage Monitoring

Accommodation

CD

PM

Application of Employment Policies including Disciplinary, Dignity at Work etc (with subsequent input from PM).

LM

Ensure Professional Registration is up to date

LM

PTM

Annual Leave* Annual leave to be arranged locally within the Cluster via paper based method. Staff member to request AL via ESR; LM to approve annual leave agreed with Cluster

LM

PM

Sick Leave and Other Absence Categories Staff member to phone in sick to practice that they were supposed to be attending that day and also to telephone LM so that period of absence can be started on ESR

LM

PM

Expenses A base needs to be agreed for each member. Expenses approved by LM

LM

Compliments & Concerns LM PM

Cluster Manager Name………………. Signature………... Date…………………

Professional Team Lead Name…………………… Signature……………… Date……………………

Community Director Name………………… Signature………… Date…………………

Designated PM Lead Name……………….……… Signature…………………… Date…………………………

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Resource Pack 37

Cluster Development - Knowledge, Skills and Training Survey

One of the core aims of cluster development is to identify what knowledge and skills the cluster stakeholders want to develop in order to progress the planning, integration and collaboration to deliver services on behalf of the patients. This training and skills survey may be helpful in identifying development needs. Please tick ONE box to indicate your level of confidence in the overall topic and ONE box as to whether you would like some training / support to develop your understanding.

How confident are you overall?

Would you like training?

N/A

Not at

all

Slig

htly

Very

Yes

No

Planning & Local Understanding of Need Information : Can you look at activity information and draw conclusions about

what is useful to investigate further? Can you focus on variation rather than data?

Integrated Medium Term Plan : Do you know what the Health Boards priorities

for service development and delivery are and how to influence this in future years?

Public Health : Do you have an overall understanding of the needs and issues

facing your local population and where to focus your energy to reduce inequalities?

Integration

Stakeholders : do you understand the roles of different stakeholders who deliver

care within the Locality, their priorities and influences?

Interface : do you understand how you may impact other parts of the “system” by

decision making in one area or on one pathway?

Negotiation / Influencing : Do you know how to communicate when there is a

difference of opinion and move towards a mutually beneficial consensus?

Team working & decision making : have you considered how you move from a

group to a team, and what support you may need to become an increasingly effective Locality?

Workforce mapping and development needs : do you understand the

development needs of the workforce in the Cluster and what the key risks to workforce are for the future and how to mitigate them?

Quality Improvement

Access : Do you really understand your access, whether this makes patients go

elsewhere, how to map what you need and options to resolve?

Choosing well : do you understand the Choose Well campaign and how to align

it to Cluster plans / what support is available to support this?

Pathway Mapping : Do you know how to map a clinical pathway from beginning

to end, identify the problems and redesign it?

Business Case Development: do you know how to pull a business case

together, how to present it and enable shifts in service/funding to happen?

Project Management : do you know how to manage a project to ensure it

delivers on time, within budget and for the highest positive impact?

Peer Review : how well do you communicate with each other to review

information, outcomes and experiences in order to identify opportunities for improvement?

Referral Review : Do you know how to discuss referrals in a team, draw

conclusions and make appropriate changes?

Risk Stratification : do you know how to identify key groups of patients who

would benefit from a more planned approach to their care, do you do this in an integrated way?

Governance : do you know how to manage conflicts of interest, and what

governance you need as a Cluster to stay safe and legal?

Risk : do you know how to spot, manage and mitigate risks?

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Resource Pack 38

Data Sharing Agreement (DSA) This Data Sharing Contract (DSC) defines the arrangements for processing data between the respective GP Practices which make up the xx GP Cluster Network and x Cluster and sits underneath the overarching GP Record Viewing Agreement and Standard Operating Procedure.

a) Parties to the agreement:

Full names of the organisations or businesses:

Xx Surgery

Xx Medical Centre

Xx Health Centre

etc

Why is the information being shared?

The identifiable data is required to inform appropriate treatment to be given to patients at xx Cluster by professional role.

Example of background, e.g. The Vision 360 allows multiple users to access a shared record from both Vision 360 GP and EMIS Web practices, with all practices being able to refer their patients directly via a shared appointment system. Access to the shared record will give the audiologist(s) read /write access to the clinical information of that patient. What information is being shared?

Patient information held in General Practice Clinical Systems (GP Record) to be accessible by Health Board employed professional role providing direct care for a patient registered with a specific General Practice. Only pre-agreed read codes will be available for viewing by the professional role.

This document outlines READ codes that are excluded. For a full list of codes that are included please refer to the NHS Wales IHR document. See Appendix 1 for excluded Read Codes. What is your legal justification for sharing? Has consent been gained if required?

Data will only be viewed for direct personal medical care by the professional role and with the express consent of the patient requiring treatment.

In the event of a patient being incapacitated and/or not being able to give explicit consent, the professional role may view the record if they believe it will be in the best interest of the patient as part of their diagnosis and treatment. Where explicit consent is not given by the patient, the professional role will be required to record the reason for viewing the patients record.

A patient audit trail is included with the system with each individual surgery being able to track access to their individual patients.

If patients do not give consent then a manual word template will be triggered and will be securely emailed to the referring practice.

b) How will the information be shared? (e.g. data transfer - include any security measures)

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The non-identifiable patient data (i.e. Vision IDs and other fields) will be collected at source via an extraction template using ODBC connectivity from Vision3 (to be replaced by v360 once DLM 485 is released) to an excel workbook for the appointment data. Two adhoc V3 searches will also be run and exported to a shared drive (each practice will have access to their own share only) in order to collect onwards referral and ratification of DNA instances. For appointment data collected by the excel ODBC template two columns will need to be removed from the dataset in excel before saving onto the shared drive. The Adhoc flat file output as well as the excel file will only contain the Vision ID as an identifier. The excel files and adhoc flat files will not leave the practice shared folder and the data will be transported into the ABMU secured SQL database via secure DTS.

The identifiable data is required to inform appropriate treatment to be given to patients by the audiologist(s); only predetermined and pre-agreed read codes will be available for viewing by the audiologist(s) – See Appendix 1 for excluded Read Codes

INPS are current providers of the clinical system for all bar one of the GP practices within Neath Cluster and as such are not a new provider. The clinical data is not being transferred from the GP’s clinical system rather it is being made available to view by the audiologist(s) at the Primary Care Hub. This is both true for Vision and EMIS clinical data. This already happens as part of the current Primary Care delivery system and therefore is not a new privacy risk

The GP practice remains Data Controller in this respect. As such the Data Protection Act requires that the Data Processor (CCG)

only acts on instructions from the Data Controller of the respective GP practices which are parties to this agreement

has security in place that is equivalent to that imposed on the Data Controller of the respective GP practices which are parties to this agreement by the seventh Data Protection Principle

c) How will the information be stored? (e.g. secure server - include any security measures)

This is a ‘view only’ solution, the data is not being transferred from the GP’s clinical system rather it is being made available to audiologist(s) at the Primary care hub only. Data does not leave the current NHS Wales data centre as per NHS Wales contract.

d) Who will handle the information – name and job title?

Data access will be kept to a minimum with only pre-determined audiologist(s) authorised to access the records of the patient requiring treatment. Express consent must be obtained from the patient before the audiologist(s) can access the patient’s records

The audiologist(s) must ensure that access to the Data is managed, auditable and restricted to those individuals who need to process the Data for the specific purpose outlined in this DSC. In addition:

Use of the Data is for the sole purpose set out in this DSC

Personnel processing the Data must be suitably trained and authorised and made aware of their responsibilities in handling the Data prior to having access to the data.

The Data must not be shared with any other organisation or named individual not

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referred to within this DSC.

If the Data is subject to a request under the Freedom of Information Act, then the GP practice must be consulted before a response is provided.

Use of the Data must comply with all applicable legislation in relation to the Data

e) How long will the information be kept?

The data will remain on the GP’s clinical system and will therefore be subject to existing data retention regulations.

f) How will the information be destroyed?

In line with No.8 above

g) What date will the information be shared? Initial date must be later that the date of the signatures below and should give an indication of subsequent dates for regular sharing.

This DSC shall commence no earlier than the dates of signature of this DSC giving ongoing real time access to up to date clinical records as is necessary for the collection and reporting on the outcome measures.

h) When will this agreement be reviewed and by whom?

This agreement shall continue until terminated earlier by either party to the DSC

This agreement must be formally approved and signed by all parties before any information sharing takes place. All parties will ensure that the DSC and any associated documents are known and understood by all staff involved in the process. Information Governance & Caldicott – Primary Care Cluster Networks

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Resource Pack 39

Sample Cluster Communication and Engagement Strategy

1 Purpose of Strategy

The purpose of this document is to provide details of the communication and engagement goals to be achieved by Clusters in LHB area to ensure that all interested parties are informed about and have the opportunity to engage in the activities of these Clusters. This Strategy should be formally adopted by each Cluster and they should use this to help inform their local communication and engagement plans.

2 Aims and objectives of this Communication and Engagement Strategy

The aim of this strategy is to outline the way in which the Clusters in LHB area can communicate and engage with key stakeholders. It will ensure that:

Those people, who need to be involved, are involved.

Feedback from stakeholders informs Cluster plans and activities.

Stakeholders are informed of the results of their inputs. The Strategy will provide ideas and innovation about how Clusters can:

Establish a 2-way communication mechanism that ensures effective communication between Networks members and their colleagues.

Share good practice amongst members and with other networks and locality groups.

Engage with key organisations and stakeholders on specific areas of work within the work programme.

3 Stakeholder analysis

To inform their communication and engagement activities, each Cluster should undertake a local stakeholder analysis which will help them identify who they need to engage with, when, why and with what type of communication tool – eg a newsletter, one to one meetings, presentations etc. To assist Clusters, an initial stakeholder analysis has been undertaken and a stakeholder communication matrix/action plan template developed. The matrix template is attached at the end of this document Obviously the process adopted by each Cluster needs to be tailored to meet the needs of each respective neighbourhood which means that the consultation processes taken forward in each of the Cluster areas may be different. The Divisional officers will support Clusters through the provision of standardised resources where applicable and these should be used to ensure that a consistent and corporate message is given out across Gwent.

4 Ask the audience There are a wide range of mechanisms which can be used to aid communication between the Clusters and their colleagues and stakeholders and examples of these are:

1. Staff forums

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2. Posts on organisational websites 3. Viral campaigns 4. Intranet Q&A Forums 5. Focus groups 6. Blogs 7. Standard presentation with the development of a meetings matrix which would help

localities keep a log of which groups have been briefed, when and by whom. 8. One to ones with influential people 9. Breaking news emails to all staff updating as things happen 10. Briefings

Clusters should ask their key stakeholders how they would like to be communicated with.

5 Promotional materials Corporate promotional materials e.g. posters, information leaflets, may be available to support Clusters in their local communication and engagement work.

6 Targeted communication/engagement which should be carried out by Clusters

Further discussion is required to determine who is responsible for different aspects of communication/engagement ie the Clusters will be responsible for the majority of this work, supported and co-ordinated by Divisional staff.

6.1 Primary Care Based on feedback from primary care practitioners, it is recommended that practice based meetings are held for their Clinical Leads.

6.2 Strategic Groups

A presentation should be made to key strategic groups on Setting the Direction, by key Cluster representatives, using the standard presentation and incorporating locality information as appropriate. Regular updates should be provided on an ongoing basis.

6.3 Cluster Chairs

Chairs of Clusters should meet together to act as a support network and to provide a means of sharing information.

7 General communication/engagement

Clusters will need to develop local engagement processes to consult on service planning, priority setting and service option appraisal.

7.1 Communicating with the General Public A list of local newsletters should be developed and articles regularly produced to keep the general public of each Locality up to date. For example Local authorities have a local magazine e.g. Torfaen has Torfaen Talks which is delivered to every household in Torfaen. Communication should be in a format accessible to those who may have limited literacy skills. Equality issues might need to be considered, particularly in Newport with a large ethnic population. Also larger fonts and other considerations might need to be given re the older

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populations’ communication resources requirements. Articles and press releases will be regularly sent to the press only after consideration and sign off by Clusters.

7.2 Cluster Network Establishing a network of Cluster Champions across communities is a good way of embedding messages and providing local contacts who can give immediate, up to date information. Clusters will need to identify key people across the NHS, Local Authority and Third Sector (both operational and strategic) who could become responsible for cascading news about the Networks. These people should then be contacted to ask if they would act as CLUSTER Champions to help promote the new model.

7.3 Champions Database A database of email addresses should be established which would act as the key way of distributing information about Clusters across organizations, services, strategic planning groups and communities. This will help to build a picture of the work of the Cluster across the patch and developing a mechanism to use when stakeholder engagement is required. This will provide a timely effective means of providing updates on Cluster activity and positively promote what is happening locally. This distribution list could also be used to circulate any “Breaking News” items, to ensure that our stakeholders receive information “hot off the press” and are kept abreast of what is happening locally, as and when it happens.

7.4 Updates on websites

Cluster updates should feature on Local HB and local authority websites. Requests should also be made to local organizations to ask if they will feature Cluster updates on their websites.

8 Monitoring Effectiveness of communication Ensuring that comments, information requests, advice and any feedback is considered will be vital to the successful development of the new model.

9 Feedback

Feedback from all local engagement activities should be considered and used to ensure that communication tools are adapted to meet the needs and answer the queries of specific audiences. Feedback to stakeholders will be given using the methods and processes that are adopted to communicate and engage.

Communication and Training Strategy – South Wrexham Cluster Cluster Development Action Plans